Intraocular lens with post-implantation adjustment capabilities

ABSTRACT

Disclosed are accommodating intraocular lenses for implantation in an eye having an optical axis. In certain embodiments, an intraocular lens includes an anterior optic, a posterior optic, and a support structure configured to move the optics relative to each other along an optical axis between an accommodated state and an unaccommodated state. In certain embodiments, at least a portion of the support structure can be modified in situ to alter reaction forces between the support structure and at least one structure of the eye. In certain embodiments, a refractive property of one of the anterior or posterior optics can be modified in situ while leaving the refractive properties of the remaining one of the anterior or posterior optics substantially unaffected. Additional embodiments and methods are also disclosed.

RELATED APPLICATION

This application is related to, and claims the benefit of U.S.Provisional 60/948,170 filed Jul. 5, 2007, the entirety of which ishereby incorporated by reference herein and made a part of the presentspecification.

BACKGROUND

1. Field

The inventions relate to lenses and, more particularly, to intraocularlenses, the performance of which can be adjusted post-operatively oranytime after implantation in the eye.

2. Description of the Related Art

Cataract operations frequently involve the implantation of an artificiallens following cataract removal. Often, these lenses have a fixed focallength or, in the case of bifocal or multifocal lenses, can have severaldifferent fixed focal lengths. Known lenses can suffer from a variety ofdrawbacks.

SUMMARY

In some embodiments, a method of modifying an accommodating intraocularlens having an anterior optic, a posterior optic, and a supportstructure is provided. The method can involve modifying one or moreportions of the intraocular lens after implantation (e.g.,post-operatively or during a later sate of a procedure) in an eye. Inone method, energy can be applied to at least a portion of the supportstructure to alter reaction forces between the support structure and atleast one structure of the eye. In another method, energy can be appliedto at least a portion of the anterior optic to alter the power of theoptic, e.g., by altering the refractive index thereof. In anothermethod, energy can be applied to at least a portion of the posterioroptic to alter the power of the optic, e.g., by altering the refractiveindex thereof. In another method, energy can be applied to at least aportion of both of the anterior optic and the posterior optic to alterthe power of both of the anterior optic and the posterior optic. Inanother method, energy can be applied to both the support structure andto at least a portion of at least one of the anterior optic and theposterior optic to alter the power of at least one of the optics.

In some embodiments, a method of modifying an accommodating intraocularlens having a first optic and a second optic after implantation in aneye comprises non-invasively applying energy to at least a portion ofthe first optic to adjust a refractive property of the first optic whileleaving refractive properties of the second optic substantiallyunaffected. The method can also comprise, in some embodiments,non-invasively applying energy to at least a portion of the second opticto alter refractive properties of the second optic while leavingrefractive properties of the first optic substantially unaffected. Insome embodiments, a first energy source is applied to the first opticand a second energy source different from the first energy source isapplied to the second optic. In some embodiments, the first opticcomprises a first material responsive to the first energy source and thesecond optic comprises a second material responsive to the second energysource.

In some embodiments, a method of adjusting an intraocular lens having ananterior optic and a posterior optic after implantation in an eyecomprises non-invasively applying energy to at least a portion of one ofsaid anterior optic and said posterior optic while the lens is in theeye to alter a refractive property of said one of said optics whileleaving refractive properties of a remaining one of said opticssubstantially unaffected.

In some embodiments, a method of modifying an accommodating intraocularlens comprising an anterior viewing element and a posterior viewingelement comprises applying energy to one or more of the anterior andposterior viewing elements to change the index of refraction of the oneor more viewing elements. In some embodiments, applying energy to one ofthe optics to change the index of refraction of the one optic leavesrefractive properties of the remaining optic substantially unaffected.

In some embodiments, a method of modifying an accommodating intraocularlens comprising an anterior viewing element and a posterior viewingelement comprises applying energy to one or more of the anterior andposterior viewing elements to change the shape (e.g., the curvature) ofthe one or more viewing elements.

In some embodiments, a method of modifying an accommodating intraocularlens comprising an anterior viewing element and a posterior viewingelement comprises applying energy to one or more of the anterior andposterior viewing elements to change the power of the one or moreviewing elements.

In some embodiments, a method of modifying an accommodating intraocularlens comprising an anterior portion having an anterior viewing elementand an anterior biasing element and a posterior portion having aposterior viewing element and a posterior biasing element comprisesapplying energy to one or more of the anterior biasing element and theposterior biasing element to change the stiffness of the one or morebiasing elements.

In some embodiments, a method of modifying an accommodating intraocularlens comprising an anterior portion having an anterior viewing elementand an anterior biasing element and a posterior portion having aposterior viewing element and a posterior biasing element comprisesapplying energy to one or more of the anterior biasing element and theposterior biasing element to change the spring constant of the one ormore biasing elements.

In some embodiments, a method of modifying an accommodating intraocularlens comprising an anterior portion having an anterior viewing elementand an anterior biasing element and a posterior portion having aposterior viewing element and a posterior biasing element comprisesapplying energy to one or more of the anterior biasing element and theposterior biasing element to alter the separation of the anterior andposterior viewing elements, where the separation is that of the viewingelements when the viewing elements are in an unaccommodated state.

In some embodiments, an accommodating intraocular lens for implantationin an eye has an optical axis. The lens comprises an anterior portionwhich in turn comprises an anterior viewing element comprised of anoptic having refractive power and an anterior biasing element comprisingfirst and second anterior translation members extending from theanterior viewing element. The lens further comprises a posterior portionwhich in turn comprises a posterior viewing element in spacedrelationship to the anterior viewing element and a posterior biasingelement comprising first and second posterior translation membersextending from the posterior viewing element. The anterior portion andposterior portion meet at first and second apices of the intraocularlens such that a plane perpendicular to the optical axis and passingthrough the apices is closer to one of said viewing elements than to theother of said viewing elements. The anterior portion and the posteriorportion are responsive to force thereon to cause the separation betweenthe viewing elements to change.

In some embodiments, an accommodating intraocular lens for implantationin an eye has an optical axis. The lens comprises an anterior portion,which in turn comprises an anterior viewing element comprised of anoptic having refractive power, and an anterior biasing elementcomprising first and second anterior translation members extending fromthe anterior viewing element. The lens further comprises a posteriorportion which in turn comprises a posterior viewing element in spacedrelationship to the anterior viewing element, and a posterior biasingelement comprising first and second posterior translation membersextending from the posterior viewing element. The anterior portion andposterior portion meet at first and second apices of the intraocularlens. The anterior portion and the posterior portion are responsive toforce thereon to cause the separation between the viewing elements tochange. The first anterior translation member forms a first anteriorbiasing angle, as the lens is viewed from the side, with respect to aplane perpendicular to the optical axis and passing through the apices.The first posterior translation member forms a first posterior biasingangle, as the lens is viewed from the side, with respect to the plane.The first anterior biasing angle and the first posterior biasing angleare unequal.

In some embodiments, an accommodating intraocular lens comprises ananterior viewing element comprised of an optic having refractive powerof less than 55 diopters and a posterior viewing element comprised of anoptic having refractive power. The optics provide a combined power of15-25 diopters and are mounted to move relative to each other along theoptical axis in response to a contractile force by the ciliary muscle ofthe eye upon the capsular bag of the eye. The relative movementcorresponds to change in the combined power of the optics of at leastone diopter. Alternatively, the accommodating intraocular lens canfurther comprise a posterior viewing element comprised of an optichaving a refractive power of zero to minus 25 diopters.

In some embodiments, an accommodating intraocular lens comprises ananterior portion which in turn comprises an anterior viewing elementwhich has a periphery and is comprised of an optic having refractivepower. The anterior portion further comprises an anterior biasingelement comprising first and second anterior translation membersextending from the anterior viewing element. The lens further comprisesa posterior portion which in turn comprises a posterior viewing elementhaving a periphery, the posterior viewing element being in spacedrelationship to the anterior viewing element, and a posterior biasingelement comprising first and second posterior translation membersextending from the posterior viewing element. The first anteriortranslation member and the first posterior translation member meet at afirst apex of the intraocular lens, and the second anterior translationmember and the second posterior translation member meet at a second apexof the intraocular lens, such that force on the anterior portion and theposterior portion causes the separation between the viewing elements tochange. Each of the translation members is attached to one of theviewing elements at least one attachment location. All of the attachmentlocations are further away from the apices than the peripheries of theviewing elements are from the apices.

In some embodiments, an accommodating intraocular lens comprises ananterior portion comprised of a viewing element. The viewing element iscomprised of an optic having refractive power. The lens furthercomprises a posterior portion comprised of a viewing element. Theviewing elements are mounted to move relative to each other along theoptical axis in response to force generated by the ciliary muscle of theeye. The lens further comprises a distending portion comprised of adistending member having a fixed end attached to the posterior portionand a free end sized and oriented to distend a portion of the lenscapsule such that coupling of forces between the lens capsule and theintraocular lens is modified by the distending portion.

Some embodiments comprise an accommodating intraocular lens. The lenscomprises an anterior portion comprised of an anterior viewing elementand an anterior biasing element connected to the anterior viewingelement. The anterior viewing element is comprised of an optic havingrefractive power. The lens further comprises a posterior portioncomprised of a posterior viewing element and a posterior biasing elementconnected to the posterior viewing element. The lens has an optical axiswhich is adapted to be substantially coincident with the optical axis ofthe eye upon implantation of the lens. The anterior and posteriorviewing elements are mounted to move relative to each other along theoptical axis in response to force generated by the ciliary muscle of theeye. The biasing elements are joined at first and second apices whichare spaced from the optical axis of the lens. The lens further comprisesa distending member extending between the first and second apices.

In some embodiments, an accommodating intraocular lens comprises ananterior portion comprised of a viewing element. The viewing element iscomprised of an optic having refractive power. The lens furthercomprises a posterior portion comprised of a viewing element. Theviewing elements are mounted to move relative to each other along theoptical axis in response to force generated by the ciliary muscle of theeye. The lens further comprises a retention portion comprised of aretention member having a fixed end attached to the anterior portion anda free end sized and oriented to contact a portion of the lens capsulesuch that extrusion of the implanted lens through the lens capsuleopening is inhibited.

Some embodiments comprise an accommodating intraocular lens. The lenscomprises an anterior portion comprised of a viewing element, theviewing element comprised of an optic having refractive power, and aposterior portion comprised of a viewing element. The viewing elementsare mounted to move relative to each other along the optical axis inresponse to force generated by the ciliary muscle of the eye. The lensfurther comprises a distending portion comprised of a distending memberattached to one of the portions, and oriented to distend the lenscapsule such that the distance between a posterior side of the posteriorviewing element and an anterior side of the anterior viewing elementalong the optical axis is less than 3 mm when the ciliary muscle isrelaxed and the lens is in an unaccommodated state.

Some embodiments comprise an accommodating intraocular lens. The lenscomprises an anterior portion comprised of a viewing element, theviewing element comprised of an optic having refractive power, and aposterior portion comprised of a viewing element. The viewing elementsare mounted to move relative to each other along the optical axis inresponse to force generated by the ciliary muscle of the eye. The lensfurther comprises a distending portion comprised of a distending memberattached to one of the portions, and oriented to distend the lenscapsule. The distending causes the lens capsule to act on at least oneof the posterior and anterior portions such that separation between theviewing elements is reduced when the ciliary muscle is relaxed and thelens is in an unaccommodated state.

Some embodiments comprise an accommodating intraocular lens. The lenscomprises an anterior portion comprised of a viewing element, theviewing element comprised of an optic having refractive power, and aposterior portion comprised of a viewing element. The viewing elementsare mounted to move relative to each other along the optical axis inresponse to force generated by the ciliary muscle of the eye. The lensfurther comprises a distending member attached to the posterior portion.The distending member is separate from the biasing members and reshapesthe lens capsule such that force coupling between the ciliary muscle andthe lens is modified to provide greater relative movement between theviewing elements when the lens moves between an unaccommodated state andan accommodated state in response to the ciliary muscle.

Some embodiments comprise an accommodating intraocular lens. The lenscomprises an anterior portion comprised of an anterior viewing elementand an anterior biasing element connected to the anterior viewingelement, the anterior viewing element being comprised of an optic havingrefractive power. The lens further comprises a posterior portioncomprised of a posterior viewing element and a posterior biasing elementconnected to the posterior viewing element. The lens has an optical axiswhich is adapted to be substantially coincident with the optical axis ofthe eye upon implantation of the lens. The anterior and posteriorviewing elements are mounted to move relative to each other along theoptical axis in response to force generated by the ciliary muscle of theeye. The biasing elements are joined at first and second apices whichare spaced from the optical axis of the lens. The lens further comprisesfirst and second distending members. Each of the members is attached toone of the anterior and posterior portions and extends away from theoptical axis. The first member is disposed between the apices on oneside of the intraocular lens and the second member is disposed betweenthe apices on the opposite side of the intraocular lens. The distendingmembers are oriented to distend portions of the lens capsule such thatthe viewing elements are relatively movable through a range of at least1.0 mm in response to contraction of the ciliary muscle.

In some embodiments, an accommodating intraocular lens comprises ananterior portion which is in turn comprised of a viewing element. Theanterior viewing element is comprised of an optic having a diameter ofapproximately 3 mm or less and a refractive power of less than 55diopters. The lens further comprises a posterior portion comprised of aviewing element. The viewing elements are mounted to move relative toeach other along the optical axis in response to force generated by theciliary muscle of the eye. The lens further comprises a distendingportion comprised of a distending member having a fixed end attached tothe posterior portion and a free end sized and oriented to distend aportion of the lens capsule such that coupling of forces between thelens capsule and the intraocular lens is increased.

Some embodiments comprise an accommodating intraocular lens. The lenscomprises an anterior portion comprised of a viewing element, theanterior viewing element being comprised of an optic having a refractiveportion with a refractive power of less than 55 diopters. The lensfurther comprises a posterior portion comprised of a viewing element.The lens has an optical axis which is adapted to be substantiallycoincident with the optical axis of the eye upon implantation of thelens. The posterior viewing element comprises an optic arrangedsubstantially coaxially with the anterior optic on the optical axis ofthe lens. The posterior optic has a larger diameter than the refractiveportion of the anterior optic. The posterior optic comprises aperipheral portion having positive refractive power and extendingradially away from the optical axis of the lens beyond the periphery ofthe refractive portion of the anterior optic, so that at least a portionof the light rays incident upon the posterior optic can bypass therefractive portion of the anterior optic.

Some embodiments comprise an accommodating intraocular lens. The lenscomprises an anterior portion comprised of a viewing element, theanterior viewing element being comprised of an optic having a refractivepower of less than 55 diopters. The lens further comprises a posteriorportion comprised of a viewing element. The lens has an optical axiswhich is adapted to be substantially coincident with the optical axis ofthe eye upon implantation of the lens. The posterior viewing elementcomprises an optic arranged substantially coaxially with the anterioroptic on the optical axis of the lens. The posterior optic has a largerdiameter than the anterior optic. The posterior optic comprises aperipheral portion having positive refractive power and extendingradially away from the optical axis of the lens beyond the periphery ofthe anterior optic, so that at least a portion of the light raysincident upon the posterior optic can bypass the anterior optic.

Some embodiments comprise an intraocular lens. The lens comprises anoptic and a pair of elongate members extending from the optic. Themembers are comprised of a shape memory alloy.

In some embodiments, an accommodating intraocular lens for implantationin an eye has an optical axis and a lens capsule having a capsuleopening for receiving the lens. The lens comprises a posterior portioncomprised of a posterior viewing element, and an anterior portioncomprised of an anterior viewing element. The anterior viewing elementis comprised of an optic having refractive power. The viewing elementsare mounted to move relative to each other along the optical axis inresponse to force generated by the ciliary muscle of the eye. Theanterior portion is adapted to contact portions of the lens capsulewhile being spaced from the lens capsule in at least one location so asto provide a fluid flow channel that extends from a region between theviewing elements to a region outside the capsule.

Some embodiments comprise an accommodating intraocular lens. The lenscomprises an anterior portion which in turn comprises an anteriorviewing element having a periphery and comprised of an optic havingrefractive power, and an anterior biasing element comprising at leastone anterior translation member attached to a first attachment area onthe periphery of the anterior viewing element. The first attachment areahas a thickness in a direction substantially perpendicular to theperiphery and a width in a direction substantially parallel to theperiphery. The ratio of the width to the thickness is equal to orgreater than 3.

In certain embodiments, a method of manufacturing an intraocular lenshaving anterior and posterior viewing elements arranged along a commonoptical axis comprises defining an anterior viewing element mold spaceand a posterior viewing element mold space, arranging the anteriorviewing element mold space and the posterior viewing element mold spacealong a mold axis substantially coincident with the optical axis of thelens, and molding the anterior viewing element in the anterior viewingelement mold space while the anterior viewing element mold space and theposterior viewing element mold space are arranged substantially alongthe mold axis.

In certain embodiments, a method of preparing an accommodatingintraocular lens having an optical axis for subsequent implantationcomprises providing an intraocular lens having first and second viewingelements interconnected by plural members. At least a portion of themembers are disposed from the optical axis by a distance greater than aperiphery of at least one of the viewing elements. This distance ismeasured orthogonal to the optical axis. The method further comprisesdrawing the members inwardly toward the optical axis by relativelyrotating the first and second viewing elements. In one variation of themethod, the first and second viewing elements are relatively rotatedabout the optical axis.

In some embodiments, an accommodating intraocular lens comprises ananterior portion having an anterior viewing element, and a posteriorportion having a posterior viewing element. The viewing elements arepositioned to move relative to each other along an optical axis inresponse to action of the ciliary muscle of the eye. The anterior andposterior portions comprise a single piece of material.

In some embodiments, an accommodating intraocular lens comprises firstand second optics. At least one of the optics has refractive power. Theoptics are mounted by an articulated frame to move relative to eachother along an optical axis in response to action of a ciliary muscle.The frame is formed of a single piece of material. In one variation ofthe lens, at least one of the optics is formed of a material which isdifferent from the material of the frame.

In some embodiments, an accommodating intraocular lens comprises ananterior portion having an anterior viewing element comprising an optichaving refractive power. The lens further comprises a posterior portionhaving a posterior viewing element. The viewing elements are positionedto move relative to each other along an optical axis in response toaction of the ciliary muscle of the eye. At least one of the anteriorand posterior portions has at least one separation member with a contactsurface. The at least one separation member is configured to preventcontact between the anterior viewing element and the posterior viewingelement by inhibiting relative movement of the anterior and posteriorportions toward each other beyond a minimum separation distance. Thecontact surface contacts an opposing surface of the intraocular lensover a contact area when the portions are at the minimum separationdistance. At least one of the surfaces has an adhesive affinity for theother of the surfaces. The contact area is sufficiently small to preventadhesion between the surfaces when the anterior portion and theposterior portion are separated by the minimum separation distance. Inone variation of the lens, the contact surface and the opposing surfaceare comprised of the same material.

In some embodiments, an intraocular lens comprises first and secondinterconnected viewing elements mounted to move relative to each otheralong an optical axis in response to action of a ciliary muscle. Atleast one of the viewing elements includes an optic having refractivepower. The lens is formed by the process of providing a first outer moldand a second outer mold, and an inner mold therebetween. The first outermold and the inner mold define a first mold space, and the second outermold and the inner mold define a second mold space. The process furthercomprises molding the viewing elements and the optic as a single pieceby filling the first and second mold spaces with a material, such thatthe first viewing element is formed in the first mold space and thesecond viewing element is formed in the second mold space. The processfurther comprises removing the first and second outer molds from thelens while the inner mold remains between the viewing elements, andremoving the inner mold from between the viewing elements while theviewing elements remain interconnected.

In some embodiments, a method of making an intraocular lens having firstand second interconnected viewing elements wherein at least one of theviewing elements includes an optic having refractive power comprisesproviding a first outer mold and a second outer mold, and an inner moldtherebetween. The first outer mold and the inner mold define a firstmold space, and the second outer mold and the inner mold define a secondmold space. The process further comprises molding the viewing elementsand the optic as a single piece by filling the first and second moldspaces with a material, such that the first viewing element is formed inthe first mold space and the second viewing element is formed in thesecond mold space. The process further comprises removing the first andsecond outer molds from the lens while the inner mold remains betweenthe viewing elements, and removing the inner mold from between theviewing elements while the viewing elements remain interconnected. Inone variation, providing the inner mold may comprise molding the innermold. In another variation, the inner mold has a first inner mold faceand a second inner mold face opposite the first inner mold face, andproviding the inner mold comprises machining the inner mold, which inturn comprises machining the first inner mold face and the second innermold face in a single piece of material.

In some embodiments, an accommodating intraocular lens comprises firstand second optics. At least one of the optics has refractive power. Theoptics are mounted to move relative to each other along an optical axisin response to action of a ciliary muscle. The first optic is formed ofa first polymer having a number of recurring units includingfirst-polymer primary recurring units, and the second optic is formed ofa second polymer having a number of recurring units includingsecond-polymer primary recurring units. No more than about 10 molepercent of the recurring units of the first polymer are the same as thesecond-polymer primary recurring units and no more than about 10 molepercent of the recurring units of the second polymer are the same as thefirst-polymer primary recurring units. In one variation, the first opticmay comprise an anterior optic, the second optic may comprise aposterior optic, the first polymer may comprise silicone, and the secondpolymer may comprise acrylic. In another variation, the first optic maycomprise an anterior optic, the second optic may comprise a posterioroptic, the first polymer may comprise high-refractive-index silicone,and the second polymer may comprise hydrophobic acrylic.

BRIEF DESCRIPTION OF THE DRAWINGS

Having thus summarized the general nature of the disclosure, certainpreferred embodiments and modifications thereof will become apparent tothose skilled in the art from the detailed description herein havingreference to the figures that follow, of which:

FIG. 1 is a sectional view of the human eye, with the lens in theunaccommodated state.

FIG. 2 is a sectional view of the human eye, with the lens in theaccommodated state.

FIG. 3 is a perspective view of one embodiment of an intraocular lenssystem.

FIG. 4 is a side view of the lens system.

FIG. 5 is a rear perspective view of the lens system.

FIG. 6 is a front view of the lens system.

FIG. 7 is a rear view of the lens system.

FIG. 8 is a top view of the lens system.

FIG. 9 is a side sectional view of the lens system.

FIG. 10 is a top sectional view of the lens system.

FIG. 11 is a second perspective view of the lens system.

FIG. 12 is a third perspective view of the lens system.

FIG. 13 is a side view of the lens system in the unaccommodated state.

FIG. 14 is a side sectional view of the lens system in theunaccommodated state.

FIG. 15 is a top sectional view of the lens system in the unaccommodatedstate.

FIG. 16 is a sectional view of the human eye with the lens systemimplanted in the capsular bag and the lens system in the accommodatedstate.

FIG. 17 is a sectional view of the human eye with the lens systemimplanted in the capsular bag and the lens system in the unaccommodatedstate.

FIG. 17A is a sectional view of an arm of the lens system.

FIG. 17B is a sectional view of another embodiment of the arm of thelens system.

FIGS. 17C-17L are sectional views of other embodiments of the arm of thelens system.

FIG. 17M is a side sectional view of another embodiment of the lenssystem.

FIG. 17N is a side sectional view of another embodiment of the lenssystem.

FIG. 18 is a side view of another embodiment of the lens system.

FIG. 19 is a side sectional view of another embodiment of the lenssystem.

FIG. 20 is a rear perspective view of another embodiment of the lenssystem.

FIG. 21 is a partial top sectional view of another embodiment of thelens system, implanted in the capsular bag.

FIG. 21A is a front view of another embodiment of the lens system.

FIG. 21B is a front view of another embodiment of the lens system.

FIG. 21C is a front view of another embodiment of the lens system.

FIG. 22 is a partial side sectional view of another embodiment of thelens system, implanted in the capsular bag.

FIG. 22A is a side view of a stop member system employed in oneembodiment of the lens system.

FIG. 23 is a side view of a mold system for forming the lens system.

FIG. 24 is a side sectional view of the mold system.

FIG. 25 is a perspective view of a first mold portion.

FIG. 26 is a perspective view of a second mold portion.

FIG. 27 is a top view of the second mold portion.

FIG. 28 is a side sectional view of the second mold portion.

FIG. 29 is another side sectional view of the second mold portion.

FIG. 30 is a bottom view of a center mold portion.

FIG. 31 is a top view of the center mold portion.

FIG. 32 is a sectional view of the center mold portion.

FIG. 33 is another sectional view of the center mold portion.

FIG. 34 is a perspective view of the center mold portion.

FIG. 34A is a partial cross sectional view of an apex of the lenssystem, showing a set of expansion grooves formed therein.

FIG. 35 is a schematic view of another embodiment of the lens system.

FIG. 36 is a schematic view of another embodiment of the lens system.

FIG. 37 is a perspective view of another embodiment of the lens system.

FIG. 38 is a top view of another embodiment of the lens system.

FIG. 38A is a schematic view of another embodiment of the lens system,as implanted in the capsular bag.

FIG. 38B is a schematic view of the embodiment of FIG. 38A, in theaccommodated state.

FIG. 38C is a schematic view of biasers installed in the lens system.

FIG. 38D is a schematic view of another type of biasers installed in thelens system.

FIG. 38E is a perspective view of another embodiment of the lens system.

FIGS. 39A-39B are a series of schematic views of an insertion techniquefor use in connection with the lens system

FIG. 40 is a schematic view of fluid-flow openings formed in theanterior aspect of the capsular bag.

FIG. 40A is a front view of the lens system, illustrating one stage of afolding technique for use with the lens system.

FIG. 40B is a front view of the lens system, illustrating another stageof the folding technique.

FIG. 40C illustrates another stage of the folding technique.

FIG. 40D illustrates another stage of the folding technique.

FIG. 40E illustrates another stage of the folding technique.

FIG. 40F illustrates another stage of the folding technique.

FIG. 40G is a perspective view of a folding tool for use with the lenssystem.

FIG. 41 is a sectional view of an aspheric optic for use with the lenssystem.

FIG. 42 is a sectional view of an optic having a diffractive surface foruse with the lens system.

FIG. 43 is a sectional view of a low-index optic for use with the lenssystem.

FIG. 44 is a side elevation view of another embodiment of the lenssystem with a number of separation members.

FIG. 45 is a front elevation view of the lens system of FIG. 44.

FIG. 46 is an overhead sectional view of the lens system of FIG. 44.

FIG. 47 is an overhead sectional view of the lens system of FIG. 44,with the viewing elements at a minimum separation distance.

FIG. 48 is a closeup view of the contact between a separation member andan opposing surface.

FIG. 49 is a side sectional view of an apparatus and method formanufacturing a center mold.

FIG. 50 is another side sectional view of the apparatus and method ofFIG. 49.

FIG. 51 is another side sectional view of the apparatus and method ofFIG. 49.

FIG. 52 is another side sectional view of the apparatus and method ofFIG. 49.

FIG. 53 is another side sectional view of the apparatus and method ofFIG. 49.

FIG. 54 is a side sectional view of the lens system in position on thecenter mold.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS I. The Human Eye andAccommodation

FIGS. 1 and 2 show the human eye 50 in section. Of particular relevanceto the present disclosure are the cornea 52, the iris 54 and the lens56, which is situated within the elastic, membranous capsular bag orlens capsule 58. The capsular bag 58 is surrounded by and suspendedwithin the ciliary muscle 60 by ligament-like structures called zonules62.

As light enters the eye 50, the cornea 52 and the lens 56 cooperate tofocus the incoming light and form an image on the retina 64 at the rearof the eye, thus facilitating vision. In the process known asaccommodation, the shape of the lens 56 is altered (and its refractiveproperties thereby adjusted) to allow the eye 50 to focus on objects atvarying distances. A typical healthy eye has sufficient accommodation toenable focused vision of objects ranging in distance from infinity(generally defined as over 20 feet from the eye) to very near (closerthan 10 inches).

The lens 56 has a natural elasticity, and in its relaxed state assumes ashape that in cross-section resembles a football. Accommodation occurswhen the ciliary muscle 60 moves the lens from its relaxed or“unaccommodated” state (shown in FIG. 1) to a contracted or“accommodated” state (shown in FIG. 2). Movement of the ciliary muscle60 to the relaxed/unaccommodated state increases tension in the zonules62 and capsular bag 58, which in turn causes the lens 56 to take on athinner (as measured along the optical axis) or taller shape as shown inFIG. 1. In contrast, when the ciliary muscle 60 is in thecontracted/accommodated state, tension in the zonules 62 and capsularbag 58 is decreased and the lens 56 takes on the fatter or shorter shapeshown in FIG. 2. When the ciliary muscles 60 contract and the capsularbag 58 and zonules 62 slacken, some degree of tension is maintained inthe capsular bag 58 and zonules 62.

II. The Lens System: Structure

FIGS. 3-17 depict one embodiment of an intraocular lens system 100 whichis configured for implantation into the capsular bag 58 in place of thenatural lens 56, and is further configured to change the refractiveproperties of the eye in response to the eye's natural process ofaccommodation. With reference to FIG. 3, a set of axes is included toillustrate the sense of directional terminology which will be usedherein to describe various features of the lens system 100. The terms“anterior” and “posterior” refer to the depicted directions on theoptical axis of the lens 100 shown in FIG. 3. When the lens 100 isimplanted in an eye, the anterior direction extends toward the corneaand the posterior direction extends toward the retina, with the opticalaxis of the lens substantially coincident with the optical axis of theeye shown in FIGS. 1 and 2. The terms “left” and “right” refer to thedirections shown on the lateral axis, which is orthogonal to the opticalaxis. In addition, the terms “upper” and “lower” refer to the directionsdepicted on the transverse axis which is orthogonal to both of theoptical axis and the lateral axis.

This system of axes is depicted purely to facilitate description herein;thus, it is not intended to limit the possible orientations which thelens system 100 may assume during use. For example, the lens system 100may rotate about, or may be displaced along, the optical axis during usewithout detracting from the performance of the lens. It is clear that,should the lens system 100 be so rotated about the optical axis, thetransverse axis may no longer have an upper-lower orientation and thelateral axis may no longer have a left-right orientation, but the lenssystem 100 will continue to function as it would when oriented asdepicted in FIG. 3. Accordingly, when the terms “upper,” “lower,” “left”or “right” are used in describing features of the lens system 100, suchuse should not be understood to require the described feature to occupythe indicated position at any or all times during use of the lens system100. Similarly, such use should not be understood to require the lenssystem 100 to maintain the indicated orientation at any or all timesduring use.

As best seen in FIG. 4, the lens system 100 has an anterior portion 102which is anterior or forward of the line A-A (which represents a planesubstantially orthogonal to the optical axis and intersecting first andsecond apices 112, 116) and a posterior portion 104 which is posterioror rearward of the line A-A. The anterior portion 102 comprises ananterior viewing element 106 and an anterior biasing element 108. Theanterior biasing element 108 in turn comprises a first anteriortranslation member 110 which extends from the anterior viewing element106 to the first apex 112 and a second anterior translation member 114which extends from the anterior viewing element 106 to the second apex116. In the illustrated embodiment the first anterior translation member110 comprises a right arm 110 a and a left arm 110 b (see FIG. 3). Inaddition, the depicted second anterior translation member 114 comprisesa right arm 114 a and a left arm 114 b. However, in other embodimentseither or both of the first and second anterior translation members 110,114 may comprise a single arm or member, or more than two arms ormembers.

As best seen in FIGS. 4, 5 and 7, the posterior portion 104 includes aposterior viewing element 118 and a posterior biasing element 120. Theposterior biasing element 120 includes a first posterior translationmember 122 extending from the posterior viewing element 118 to the firstapex 112 and a second posterior translation member 124 extending fromthe posterior viewing element 118 to the second apex 116. In theillustrated embodiment, the first posterior translation member comprisesa right arm 122 a and a left arm 122 b. Likewise, the depicted secondposterior translation member 124 comprises a right arm 124 a and a leftarm 124 b. However, in other embodiments either or both of the first andsecond posterior translation members 122, 124 may comprise a single armor member, or more than two arms or members.

In the embodiment shown in FIG. 4, the anterior biasing element 108 andthe posterior biasing element are configured symmetrically with respectto the plane A-A as the lens system 100 is viewed from the side. As usedherein to describe the biasing elements 108, 120, “symmetric” or“symmetrically” means that, as the lens system 100 is viewed from theside, the first anterior translation member 110 and the first posteriortranslation member 122 extend from the first apex 112 at substantiallyequal first anterior and posterior biasing angles θ₁, θ₂ with respect tothe line A-A (which, again, represents the edge of a plane which issubstantially orthogonal to the optical axis and intersects the firstand second apices 112, 116) and/or that the second anterior translationmember 114 and the second posterior translation member 124 extend fromthe second apex 116 at substantially equal second anterior and posteriorbiasing angles θ₃, θ₄ with respect to the line A-A. Alternative orasymmetric configurations of the biasing elements are possible, as willbe discussed in further detail below. It should be further noted that asymmetric configuration of the biasing elements 108, 120 does notdictate symmetric positioning of the viewing elements with respect tothe line A-A; in the embodiment shown in FIG. 4 the anterior viewingelement 106 is closer to the line A-A than is the posterior viewingelement.

Preferably, both the anterior viewing element 106 and the posteriorviewing element 118 comprise an optic or lens having refractive power.(As used herein, the term “refractive” or “refractive power” shallinclude “diffractive” or “diffractive power”.) As discussed herein, insome embodiments, an intraocular lens such as the lens system 100 isconfigured to be modified post-operatively and in situ to change aperformance characteristic of the system. For example, one or more ofthe viewing elements 106, 118 can be configured to be modifiablepost-operatively to alter the power of the one or more viewing elementsand/or the lens system, as discussed further below. In some embodiments,the support structures of the lens system 100 are configured to bemodified post-operatively and in situ to change one or more performancecharacteristics of the support structures, such as the spring rate ofthe biasing members. The preferred power ranges for the optics arediscussed in detail below.

In alternative embodiments one or both of the anterior and posteriorviewing elements 106, 118 may comprise an optic with a surrounding orpartially surrounding perimeter frame member or members, with some orall of the biasing elements/translation members attached to the framemember(s). As a further alternative, one of the viewing elements 106,118 may comprise a perimeter frame with an open/empty central portion orvoid located on the optical axis (see FIG. 20 and discussion below), ora perimeter frame member or members with a zero-power lens ortransparent member therein. In still further variations, one of theviewing elements 106, 118 may comprise only a zero-power lens ortransparent member.

In a presently preferred embodiment, a retention portion 126 is coupledto the anterior portion 102, preferably at the anterior viewing element106. The retention portion 126 preferably includes a first retentionmember 128 and a second retention member 130, although in alternativeembodiments the retention portion 126 may be omitted altogether, or maycomprise only one retention member or more than two retention members.The first retention member 128 is coupled to the anterior viewingelement 106 at a fixed end 128 a and also includes a free end 128 bopposite the fixed end 128 a. Likewise, the second retention member 130includes a fixed end 130 a and a free end 130 b. The retention members128, 130 are illustrated as being coupled to the anterior viewingelement 106 at the upper and lower edges thereof; however, the retentionmembers 128, 130 may alternatively be attached to the anterior viewingelement 106 at other suitable edge locations.

In the preferred embodiment, the posterior portion 104 includes adistending portion 132, preferably attached to the posterior viewingelement 118. The preferred distending portion 132 includes a firstdistending member 134 which in turn includes a fixed end 134 a, a freeend 134 b opposite the fixed end 134 a and preferably also includes anopening 134 c formed therein. The preferred distending portion 132 alsocomprises a second distending member 136 with a fixed end 136 a, a freeend 136 b and preferably an opening 136 c formed therein. In alternativeembodiments, the distending portion 132 may be omitted altogether, ormay comprise a single distending member or more than two distendingmembers. To optimize their effectiveness, the preferred location for thedistending members 134, 136 is 90 degrees away (about the optical axis)from the apices 112, 116 on the posterior portion 104. Where the biasingelements form more than two apices (or where two apices are not spaced180 degrees apart about the optical axis), one or more distendingmembers may be positioned angularly midway between the apices about theoptical axis. Alternatively, the distending member(s) may occupy othersuitable positions relative to the apices (besides the “angularlymidway” positions disclosed above); as further alternatives, thedistending member(s) may be located on the anterior portion 102 of thelens system 100, or even on the apices themselves. The functions of theretention portion 126 and the distending portion 132 will be describedin greater detail below.

III. The Lens System: Function/Optics

The anterior and posterior biasing elements 108, 120 function in aspringlike manner to permit the anterior viewing element 106 andposterior viewing element 118 to move relative to each other generallyalong the optical axis. The biasing elements 108, 120 bias the viewingelements 106, 118 apart so that the elements 106, 108 separate to theaccommodated position or accommodated state shown in FIG. 4. Thus, inthe absence of any external forces, the viewing elements are at theirmaximum separation along the optical axis. The viewing elements 106, 118of the lens system 100 may be moved toward each other, in response to aciliary muscle force of up to 2 grams, to provide an unaccommodatedposition by applying appropriate forces upon the anterior and posteriorportions 102, 104 and/or the apices 112, 116.

When the lens system 100 is implanted in the capsular bag 58 (FIGS.16-17) the above described biasing forces cause the lens system 100 toexpand along the optical axis so as to interact with both the posteriorand anterior aspects of the capsular bag. Such interaction occursthroughout the entire range of motion of the ciliary muscle 60. At oneextreme the ciliary muscle is relaxed and the zonules 62 pull thecapsular bag 58 radially so as to cause the bag to become more diskshaped. The anterior and posterior sides of the bag, in turn, applyforce to the anterior and posterior portions 102, 104 of the lens system100, thereby forcing the viewing elements 106, 118 toward each otherinto the accommodated position. At the other extreme, the ciliary musclecontracts and the zonules 62 move inwardly to provide slack in thecapsular bag 58 and allow the bag to become more football-shaped. Theslack in the bag is taken up by the lens system due to the biasing-apartof the anterior and posterior viewing elements 106, 118. As the radialtension in the bag is reduced, the viewing elements 106, 118 move awayfrom each other into an accommodated position. Thus, the distancebetween the viewing elements 106, 118 depends on the degree ofcontraction or relaxation of the ciliary muscle 60. As the distancebetween the anterior and posterior viewing elements 106, 118 is varied,the focal length of the lens system 100 changes accordingly. Thus, whenthe lens system 100 is implanted into the capsular bag (see FIGS. 16-17)the lens system 100 operates in conjunction with the naturalaccommodation processes of the eye to move between the accommodated(FIG. 16) and unaccommodated (FIG. 17) states in the same manner aswould a healthy “natural” lens. Preferably, the lens system 100 can movebetween the accommodated and unaccommodated states in less than aboutone second.

The entire lens system 100, other than the optic(s), thus comprises anarticulated frame whose functions include holding the optic(s) inposition within the capsular bag and guiding and causing movement of theoptic(s) between the accommodated and unaccommodated positions.

Advantageously, the entire lens system 100 may comprise a single pieceof material, i.e. one that is formed without need to assemble two ormore components by gluing, heat bonding, the use of fasteners orinterlocking elements, etc. This characteristic increases thereliability of the lens system 100 by improving its resistance tomaterial fatigue effects which can arise as the lens system experiencesmillions of accommodation cycles throughout its service life. It will bereadily appreciated that the molding process and mold tooling discussedherein, lend themselves to the molding of lens systems 100 that comprisea single piece of material. However, any other suitable technique may beemployed to manufacture single-piece lens systems.

In those embodiments where the optic(s) are installed into annular orother perimeter frame member(s) (see discussion below), the articulatedframe may comprise a single piece of material, to obtain the performanceadvantages discussed above. It is believed that the assembly of theoptic(s) to the articulated frame will not substantially detract fromthe achievement of these advantages.

The lens system 100 has sufficient dynamic range that the anterior andposterior viewing elements 106, 118 move about 0.5-4 mm, preferablyabout 1-3 mm, more preferably about 1-2 mm, and most preferably about1.5 mm closer together when the lens system 100 moves from theaccommodated state to the unaccommodated state. In other words theseparation distance X (see FIGS. 9-10, 14-15) between the anterior andposterior viewing elements 106, 118, which distance may for presentpurposes be defined as the distance along the optical axis (or aparallel axis) between a point of axial intersection with the posteriorface of the anterior viewing element 106 and a point of axialintersection with the anterior face of the posterior viewing element118, decreases by the amount(s) disclosed above upon movement of thelens system 100 to the unaccommodated state. Simultaneously, in thepreferred mode the total system thickness Y decreases from about 3.0-4.0mm in the accommodated state to about 1.5-2.5 mm in the unaccommodatedstate.

As may be best seen in FIG. 6, the first anterior translation member 110connects to the anterior viewing element 106 via connection of the leftand right arms 110 a, 110 b to first and second transition members 138,140 at attachment locations 142, 144. The second anterior translationmember 114 connects to the anterior viewing element 106 via connectionof left and right arms 114 a, 114 b to the first and second transitionmembers 138, 140 at attachment locations 146, 148. This is a presentlypreferred arrangement for the first and second anterior translationmembers 110, 114; alternatively, the first and second anteriortranslation members 110, 114 could be connected directly to the anteriorviewing element 106, as is the case with the connection of the first andsecond posterior translation members 122, 124 to the posterior viewingelement 118.

However the connection is established between the first and secondanterior translation members 110, 114 and the anterior viewing element106, it is preferred that the attachment locations 142, 144corresponding to the first anterior translation member 110 be fartheraway from the first apex 112 than is the closest edge or the peripheryof the anterior viewing element 106. This configuration increases theeffective length of the first anterior translation member 110/arms 110a, 110 b, in comparison to a direct or straight attachment between theapex 112 and the nearest/top edge of the anterior viewing element 106.For the same reasons, it is preferred that the attachment locations 146,148 associated with the second anterior translation member 114 befarther away from the second apex 116 than is the closest/bottom edge ofthe anterior viewing element 106.

As best seen in FIG. 7, the first posterior translation member 122 ispreferably connected directly to the posterior viewing element 118 viaattachment of the left and right arms 122 a, 122 b to the element 118 atattachment points 150, 152. Likewise, the second posterior translationmember 124 is preferably directly connected to the posterior viewingelement 118 via connection of the left and right arms 124 a, 124 b tothe element 118 at attachment points 154, 156, respectively. Inalternative embodiments, the first and second posterior translationmembers 124, 122 can be connected to the posterior viewing element viaintervening members as is done with the anterior viewing element 106. Nomatter how these connections are made, it is preferred that theattachment locations 150, 152 be spaced further away from the first apex112 than is the nearest edge or the periphery of the posterior viewingelement 118. Similarly, it is preferred that the attachment locations154, 156 be spaced further away from the second apex 116 than is theclosest edge of the posterior viewing element 118.

By increasing the effective length of some or all of the translationmembers 110, 114, 122, 124 (and that of the arms 110 a, 110 b, 114 a,114 b, 122 a, 122 b, 124 a, 124 b where such structure is employed), thepreferred configuration of the attachment locations 142, 144, 146, 148,150, 152, 154, 156 relative to the first and second apices 112, 116enables the anterior and/or posterior viewing elements 106, 118 to movewith respect to one another a greater distance along the optical axis,for a given angular displacement of the anterior and/or posteriortranslation members. This arrangement thus facilitates a more responsivespring system for the lens system 100 and minimizes material fatigueeffects associated with prolonged exposure to repeated flexing.

In the illustrated embodiment, the attachment location 142 of the firstanterior translation member 110 is spaced from the correspondingattachment location 146 of the second anterior translation member 114along the periphery of the anterior viewing element, and the samerelationship exists between the other pairs of attachment locations 144,148; 150, 154; and 152, 156. This arrangement advantageously broadensthe support base for the anterior and posterior viewing elements 106,118 and prevents them from twisting about an axis parallel to thelateral axis, as the viewing elements move between the accommodated andunaccommodated positions.

It is also preferred that the attachment locations 142, 144 of the firstanterior translation member 110 be located equidistant from the firstapex 112, and that the right and left arms 110 a, 110 b of the member110 be equal in length. Furthermore, the arrangement of the attachmentlocations 146, 148, arms 114 a, 114 b and second apex preferably mirrorsthat recited above regarding the first anterior translation member 110,while the apices 112, 116 are preferably equidistant from the opticalaxis and are situated 180 degrees apart. This configuration maintainsthe anterior viewing element 106 orthogonal to the optical axis as theviewing element 106 moves back and forth and the anterior viewingelement flexes.

For the same reasons, a like combination of equidistance and equallength is preferred for the first and second posterior translationmembers 122, 124 and their constituent arms 122 a, 122 b, 124 a, 124 band attachment points 150, 152, 154, 156, with respect to the apices112, 116. However, as shown the arms 122 a, 122 b, 124 a, 124 b need notbe equal in length to their counterparts 110 a, 110 b, 114 a, 114 b inthe first and second anterior translation members 110, 114.

Where any member or element connects to the periphery of the anterior orposterior viewing elements 106, 118, the member defines a connectiongeometry or attachment area with a connection width W and a connectionthickness T (see FIG. 4 and the example illustrated therein, of theconnection of the second posterior translation member 124 to theposterior viewing element 118). For purposes of clarity, the connectionwidth is defined as being measured along a direction substantiallyparallel to the periphery of the viewing element in question, and theconnection thickness is defined as measured along a directionsubstantially perpendicular to the periphery of the viewing element.(The periphery itself is deemed to be oriented generally perpendicularto the optical axis as shown in FIG. 4.) Preferably, no attachment areaemployed in the lens system 100 has a ratio of width to thickness lessthan 3. It has been found that such a geometry reduces distortion of theviewing element/optic due to localized forces. For the same reasons, itis also preferred that each of the translation members 110, 114, 122,124 be connected to the periphery of the respective viewing elements atleast two attachment areas, each having the preferred geometry discussedabove.

FIGS. 17A and 17B show two preferred cross-sectional configurationswhich may be used along some or all of the length of the translationmembers and/or arms 110 a, 110 b, 114 a, 114 b, 122 a, 122 b, 124 a, 124b. The shape is defined by a relatively broad and flat or slightlycurved outer surface 182. It is intended that when in use the outersurface faces away from the interior of the lens system and/or towardthe capsular bag 58. The remaining surfaces, proportions and dimensionsmaking up the cross-sectional shape can vary widely but mayadvantageously be selected to facilitate manufacture of the lens system100 via molding or casting techniques while minimizing stresses in thearms during use of the lens system.

FIGS. 17C-17L depict a number of alternative cross-sectionalconfigurations which are suitable for the translation members and/orarms 110 a, 110 b, 114 a, 114 b, 122 a, 122 b, 124 a, 124 b. As shown, awide variety of cross-sectional shapes may be used, but preferably anyshape includes the relatively broad and flat or slightly curved outersurface 182.

It is further contemplated that the dimensions, shapes, and/orproportions of the cross-sectional configuration of the translationmembers and/or arms 110 a, 110 b, 114 a, 114 b, 122 a, 122 b, 124 a, 124b may vary along the length of the members/arms. This may be done inorder to, for example, add strength to high-stress regions of the arms,fine-tune their spring characteristics, add rigidity or flexibility,etc.

As discussed above, each of the anterior viewing element 106 and theposterior viewing element 118 preferably comprises an optic havingrefractive power. In one preferred embodiment, the anterior viewingelement 106 comprises a biconvex lens having positive refractive powerand the posterior viewing element 118 comprises a convexo-concave lenshaving negative refractive power. The anterior viewing element 106 maycomprise a lens having a positive power advantageously less than 55diopters, preferably less than 40 diopters, more preferably less than 35diopters, and most preferably less than 30 diopters. The posteriorviewing element 118 may comprise a lens having a power which isadvantageously between −25 and 0 diopters, and preferably between −25and −15 diopters. In other embodiments, the posterior viewing element118 comprises a lens having a power which is between −15 and 0 diopters,preferably between −13 and −2 diopters, and most preferably between −10and −5 diopters. Advantageously, the total power of the optic(s)employed in the lens system 100 is about 5-35 diopters; preferably, thetotal power is about 10-30 diopters; most preferably, the total power isabout 15-25 diopters. (As used herein, the term “diopter” refers to lensor system power as measured when the lens system 100 has been implantedin the human eye in the usual manner.) It should be noted that ifmaterials having a high index of refraction (e.g., higher than that ofsilicone) are used, the optics may be made thinner which facilitates awider range of motion for the optics. This in turn allows the use oflower-power optics than those specified above. In addition, higher-indexmaterials allow the manufacture of a higher-power lens for a given lensthickness and thereby reduce the range of motion needed to achieve agiven range of accommodation.

Some lens powers and radii of curvature presently preferred for use withan embodiment of the lens system 100 with optic(s) having a refractiveindex of about 1.432 are as follows: a +31 diopter, biconvex lens withan anterior radius of curvature of 5.944 mm and a posterior radius ofcurvature of 5.944 mm; a +28 diopter, biconvex lens with an anteriorradius of curvature of 5.656 mm and a posterior radius of curvature of7.788 mm; a +24 diopter, biconvex lens with an anterior radius ofcurvature of 6.961 mm and a posterior radius of curvature of 8.5 mm; a−10 diopter, biconcave lens with an anterior radius of curvature of18.765 mm and a posterior radius of curvature of 18.765 mm; a −8diopter, concavo-convex lens with an anterior radius of curvature ofbetween 9 mm and 9.534 mm and a posterior radius of curvature of 40 mm;and a −5 diopter, concavo-convex lens with an anterior radius ofcurvature of between 9 mm and 9.534 mm and a posterior radius ofcurvature of 20 mm. In one embodiment, the anterior viewing elementcomprises the +31 diopter lens described above and the posterior viewingelement comprises the −10 diopter lens described above. In anotherembodiment, the anterior viewing element comprises the +28 diopter lensdescribed above and the posterior viewing element comprises the −8diopter lens described above. In another embodiment, the anteriorviewing element comprises the +24 diopter lens described above and theposterior viewing element comprises the −5 diopter lens described above.

The combinations of lens powers and radii of curvature specified hereinadvantageously minimize image magnification. However, other designs andradii of curvature provide modified magnification when desirable.

The lenses of the anterior viewing element 106 and the posterior viewingelement 118 are relatively moveable as discussed above; advantageously,this movement is sufficient to produce an accommodation of at least onediopter, preferably at least two diopters and most preferably at leastthree diopters. In other words, the movement of the optics relative toeach other and/or to the cornea is sufficient to create a differencebetween (i) the refractive power of the user's eye in the accommodatedstate and (ii) the refractive power of the user's eye in theunaccommodated state, having a magnitude expressed in diopters asspecified above. Where the lens system 100 has a single optic, themovement of the optic relative to the cornea is sufficient to create adifference in focal power as specified above.

Advantageously, the lens system 100 in one embodiment can be customizedfor an individual patient's needs by shaping or adjusting only one ofthe four lens faces, and thereby altering the overall opticalcharacteristics of the system 100. This in turn facilitates easymanufacture and maintenance of an inventory of lens systems with lenspowers which will fit a large population of patients, withoutnecessitating complex adjustment procedures at the time of implantation.It is contemplated that all of the lens systems in the inventory have astandard combination of lens powers, and that a system is fitted to aparticular patient by simply shaping only a designated “variable” lensface. This custom-shaping procedure can be performed to-order at acentral manufacturing facility or laboratory, or by a physicianconsulting with an individual patient. In one embodiment, the anteriorface of the anterior viewing element is the designated sole variablelens face. In another embodiment, the anterior face of the posteriorviewing element is the only variable face. However, any of the lensfaces is suitable for such designation. The result is minimal inventoryburden with respect to lens power (all of the lens systems in stock havethe same lens powers) without requiring complex adjustment forindividual patients (only one of the four lens faces is adjusted in thefitting process). In another embodiment, any of the four faces of thetwo lens system can be customized after implantation, as discussedherein.

IV. The Lens System: Alternative Embodiments

FIG. 17M depicts another embodiment of the lens system 100 in which theanterior viewing element 106 comprises an optic with a smaller diameterthan the posterior viewing element 118, which comprises an optic with aperipheral positive-lens portion 170 surrounding a central negativeportion 172. This arrangement enables the user of the lens system 100 tofocus on objects at infinity, by allowing the (generally parallel) lightrays incident upon the eye from an object at infinity to bypass theanterior viewing element 106. The peripheral positive-lens portion 170of the posterior viewing element 118 can then function alone inrefracting the light rays, providing the user with focused vision atinfinity (in addition to the range of visual distances facilitated bythe anterior and posterior viewing elements acting in concert). Inanother embodiment, the anterior viewing element 106 comprises an optichaving a diameter of approximately 3 millimeters or less. In yet anotherembodiment, the anterior viewing element 106 comprises an optic having adiameter of approximately 3 millimeters or less and a refractive powerof less than 55 diopters, more preferably less than 30 diopters. Instill another embodiment, the peripheral positive-lens portion 170 has arefractive power of about 20 diopters.

FIG. 17N shows an alternative arrangement in which, the anterior viewingelement 106 comprises an optic having a central portion 176 withrefractive power, and a surrounding peripheral region 174 having arefractive power of substantially zero, wherein the central region 176has a diameter smaller than the optic of the posterior viewing element118, and preferably has a diameter of less than about 3 millimeters.This embodiment also allows some incident light rays to pass theanterior viewing element (though the zero-power peripheral region 174)without refraction, allowing the peripheral positive-lens portion 170posterior viewing element 118 to function alone as described above.

FIGS. 18 and 19 depict another embodiment 250 of the intraocular lens.It is contemplated that, except as noted below, this embodiment 250 islargely similar to the embodiment disclosed in FIGS. 3-17. The lens 250features an anterior biasing element 108 and posterior biasing element120 which are arranged asymmetrically as the lens system 100 is viewedfrom the side. As used herein to describe the biasing elements 108, 120,“asymmetric” or “asymmetrically” means that, as the lens system 100 isviewed from the side, the first anterior translation member 110 and thefirst posterior translation member 122 extend from the first apex 112 atunequal first anterior and posterior biasing angles δ₁, δ₂ with respectto the line B-B (which represents the edge of a plane which issubstantially orthogonal to the optical axis and intersects the firstand second apices 112, 116) and/or that the second anterior translationmember 114 and the second posterior translation member 124 extend fromthe second apex 116 at substantially equal second anterior and posteriorbiasing angles δ₃, δ₄ with respect to the line B-B.

In the embodiment shown in FIGS. 18-19, the first and second anteriorbiasing angles δ₁, δ₃ are greater than the corresponding first andsecond posterior biasing angles δ₂, δ₄. This arrangement advantageouslymaintains the posterior viewing element 118 and apices 112, 116 in asubstantially stationary position. Consequently, the moving mass of thelens system 250 is reduced, and the anterior viewing element 106 canmove more quickly over a wider range along the optical axis under agiven motive force. (Note that even where the posterior biasing element120 and its constituent first and second posterior translation members122, 124 are substantially immobile, they are nonetheless “biasingelements” and “translation members” as those terms are used herein.) Inanother embodiment, the anterior biasing element 108 and posteriorbiasing element 120 are arranged asymmetrically in the oppositedirection, i.e. such that the first and second anterior biasing anglesδ₁, δ₃ are smaller than the corresponding first and second posteriorbiasing angles δ₂, δ₄. This arrangement also provides for a wider rangeof relative movement of the viewing elements, in comparison to a“symmetric” system.

It should be further noted that the viewing elements 106, 118 shown inFIGS. 18-19 are asymmetrically positioned in that the posterior viewingelement 118 is closer to the line B-B than is the anterior viewingelement 106. It has been found that this configuration yields desirableperformance characteristics irrespective of the configuration of thebiasing elements 108, 120. In alternative embodiments, the viewingelements 106, 118 may be positioned symmetrically with respect to theline B-B, or they may be positioned asymmetrically with the anteriorviewing element 106 closer to the line B-B than the posterior viewingelement 118 (see FIG. 4 wherein the line in question is denoted A-A).Furthermore, the symmetry or asymmetry of the biasing elements andviewing elements can be selected independently of each other.

FIG. 20 shows another embodiment 350 of an intraocular lens in which theposterior viewing element 118 comprises an annular frame member defininga void therein, while the anterior viewing element 106 comprises anoptic having refractive power. Alternatively, the posterior viewingelement 118 could comprise a zero power lens or a simple transparentmember. Likewise, in another embodiment the anterior viewing element 106could comprise an annular frame member with a void therein or a simplezero power lens or transparent member, with the posterior viewingelement 118 comprising an optic having refractive power. As a furtheralternative, one or both of the anterior and posterior viewing elements106, 118 may comprise an annular or other perimeter frame member whichcan receive a removable optic (or a “one-time install” optic) with aninterference type fit and/or subsequent adhesive or welding connections.Such a configuration facilitates assembly and/or fine-tuning of the lenssystem during an implantation procedure, as will be discussed in furtherdetail below.

V. The Lens System: Additional Features

FIG. 21 depicts the function of the distending portion 132 in greaterdetail. The lens system 100 is shown situated in the capsular bag 58 inthe customary manner with the anterior viewing element 106 and posteriorviewing element 118 arranged along the optical axis. The capsular bag 58is shown with a generally circular anterior opening 66 which may oftenbe cut into the capsular bag during installation of the lens system 100.The first and second distending members 134, 136 of the distendingportion 132 distend the capsular bag 58 so that intimate contact iscreated between the posterior face of the posterior viewing elementand/or the posterior biasing element 120. In addition, intimate contactis facilitated between the anterior face of the anterior viewing element106 and/or anterior biasing element 108. The distending members 134, 136thus remove any slack from the capsular bag 58 and ensure optimum forcecoupling between the bag 58 and the lens system 100 as the bag 58 isalternately stretched and released by the action of the ciliary muscle.

Furthermore, the distending members 134, 136 reshape the capsular bag 58into a taller, thinner configuration along its range of accommodation toprovide a wider range of relative motion of the viewing elements 106,118. When the capsular bag 58 is in the unaccommodated state, thedistending members 134, 136 force the capsular bag into a thinnerconfiguration (as measured along the optical axis) in comparison to theunaccommodated configuration of the capsular bag 58 with the naturallens in place. Preferably, the distending members 134, 136 cause thecapsular bag 58 to taken on a shape in the unaccommodated state which isabout 1.0-2.0 mm thinner, more preferably about 1.5 mm thinner, alongthe optical axis than it is with the natural lens in place and in theunaccommodated state.

With such a thin “starting point” provided by the distending members134, 136, the viewing elements 106, 118 of the lens system can move agreater distance apart, and provide a greater range of accommodation,without causing undesirable contact between the lens system and theiris. Accordingly, by reshaping the bag as discussed above thedistending members 134, 136 facilitate a range of relative motion of theanterior and posterior viewing elements 106, 118 of about 0.5-4 mm,preferably about 1-3 mm, more preferably about 1-2 mm, and mostpreferably about 1.5 mm.

The distending portion 132/distending members 134, 136 are preferablyseparate from the anterior and posterior biasing elements 108, 120; thedistending members 134, 136 thus preferably play no part in biasing theanterior and posterior viewing elements 106, 118 apart toward theaccommodated position. This arrangement is advantageous because theapices 112, 116 of the biasing elements 108, 120 reach their point ofminimum protrusion from the optical axis (and thus the biasing elementsreach their minimum potential effectiveness for radially distending thecapsular bag) when the lens system 100 is in the accommodated state (seeFIG. 16), which is precisely when the need is greatest for a tautcapsular bag so as to provide immediate response to relaxation of theciliary muscles. The preferred distending portion is “static” (asopposed to the “dynamic” biasing members 108, 120 which move whileurging the viewing elements 106, 118 to the accommodated position orcarrying the viewing elements to the unaccommodated position) in thatits member(s) protrude a substantially constant distance from theoptical axis throughout the range of motion of the viewing elements 106,118. Although some degree of flexing may be observed in the distendingmembers 134, 136, they are most effective when rigid. Furthermore, thethickness and/or cross-sectional profile of the distending members134/136 may be varied over the length of the members as desired toprovide a desired degree of rigidity thereto.

The distending portion 132/distending members 132, 134 advantageouslyreshape the capsular bag 58 by stretching the bag 58 radially away fromthe optical axis and causing the bag 58 to take on a thinner, tallershape throughout the range of accommodation by the eye. This reshapingis believed to facilitate a broad (as specified above) range of relativemotion for the viewing elements of the lens system 100, with appropriateendpoints (derived from the total system thicknesses detailed above) toavoid the need for unacceptably thick optic(s) in the lens system.

If desired, the distending members 134, 136 may also function as hapticsto stabilize and fixate the orientation of the lens system 100 withinthe capsular bag. The openings 134 c, 136 c of the preferred distendingmembers 134, 136 permit cellular ingrowth from the capsular bag uponpositioning of the lens system 100 therein. Finally, othermethodologies, such as a separate capsular tension ring or the use ofadhesives to glue the capsular bag together in selected regions, may beused instead of or in addition to the distending portion 132, to reduce“slack” in the capsular bag.

A tension ring can also act as a physical barrier to cell growth on theinner surface of the capsular bag, and thus can provide additionalbenefits in limiting posterior capsule opacification, by preventingcellular growth from advancing posteriorly on the inner surface of thebag. When implanted, the tension ring firmly contacts the inner surfaceof the bag and defines a circumferential barrier against cell growth onthe inner surface from one side of the barrier to another.

FIG. 21A shows an alternative configuration of the distending portion132, in which the distending members 134, 136 comprise first and secondarcuate portions which connect at either end to the apices 112, 116 toform therewith an integral perimeter member. In this arrangement it ispreferred that the distending members and apices form an oval withheight I smaller than width J.

FIG. 21B shows another alternative configuration of the distendingportion 132, in which arcuate rim portions 137 interconnect the apices112, 116 and the free ends 134 b, 136 b of the distending members 134,136. Thus is formed an integral perimeter member with generally higherlateral rigidity than the arrangement depicted in FIG. 21A.

FIG. 21C shows another alternative configuration of the distendingportion 132, in which the distending members 134, 136 are integrallyformed with the first and second posterior translation members 122, 124.The distending members 134, 136 and translation members 122, 124 thusform common transition members 139 which connect to the periphery of theposterior viewing element 118.

FIG. 22 shows the function of the retention portion 126 in greaterdetail. It is readily seen that the first and second retention members128, 130 facilitate a broad contact base between the anterior portion ofthe lens system 100 and the anterior aspect of the capsular bag 58. Byappropriately spacing the first and second retention members 128, 130,the members prevent extrusion of the anterior viewing element 106through the anterior opening 66. It is also readily seen that wherecontact occurs between the anterior aspect of the capsular bag 58 andone or both of the retention members 128, 130, the retention membersalso participate in force coupling between the bag 58 and the lenssystem 100 as the bag is stretched and released by the action of theciliary muscles.

As best seen in FIGS. 21 and 22, the anterior portion 102 of the lenssystem 100 forms a number of regions of contact with the capsular bag58, around the perimeter of the anterior viewing element 106. In theillustrated embodiment, at least some of these regions of contact arelocated on the anteriormost portions of the anterior biasing element108, specifically at the transition members 138, 140, and at theretention members 128, 130. The transition members and the retentionmembers define spaces therebetween at the edges of the anterior viewingelement 106 to permit fluid to flow between the interior of the capsularbag 58 and the portions of the eye anterior of the bag 58. In otherwords, the anterior portion of the lens system 100 includes at least onelocation which is spaced from and out of contact with the capsular bag58 to provide a fluid flow channel extending from the region between theviewing elements 106, 118 to the exterior of the bag 58. Otherwise, ifthe anterior portion 102 of the lens system 100 seals the anterioropening 66 of the bag 58, the resulting prevention of fluid flow cancause the aqueous humor in the capsular bag to stagnate, leading to aclinically adverse event, and can inhibit the movement of the lenssystem 100 between the accommodated and unaccommodated states.

If desired, one or both of the retention members 128, 130 may have anopening 129 formed therein to permit fluid flow as discussed above. (SeeFIG. 21A.)

The retention members 128, 130 and the transition members 138, 140 alsoprevent contact between the iris and the anterior viewing element 106,by separating the anterior opening 66 from the anterior face of theviewing element 106. In other words, the retention members 128, 130 andthe transition members 138, 140 displace the anterior aspect of thecapsular bag 58, including the anterior opening 66, anteriorly from theanterior viewing element 106, and maintain this separation throughoutthe range of accommodation of the lens system. Thus, if contact occursbetween the iris and the lens system-capsular bag assembly, no part ofthe lens system will touch the iris, only the capsular bag itself, inparticular those portions of the bag 58 overlying the retention members128, 130 and/or the transition members 138, 140. The retention members128, 130 and/or the transition members 138, 140 therefore maintain aseparation between the iris and the lens system, which can be clinicallyadverse if the contacting portion(s) of the lens system are constructedfrom silicone.

As depicted in FIG. 22A, one or more stop members or separation members190 may be located where appropriate on the anterior and/or posteriorbiasing elements 108, 120 to limit the convergent motion of the anteriorand posterior viewing elements 106, 118, and preferably prevent contacttherebetween. As the lens system 100 moves toward the unaccommodatedposition, the stop member(s) located on the anterior biasing element 108come into contact with the posterior biasing element 120 (or withadditional stop member(s) located on thereon), and any stop member(s)located on the posterior biasing element 120 come into contact with theanterior biasing element 108 (or with additional stop member(s) locatedthereon). The stop members 190 thus define a point or state of maximumconvergence (in other words, the unaccommodated state) of the lenssystem 100/viewing elements 106, 118. Such definition advantageouslyassists in setting one extreme of the range of focal lengths which thelens system may take on (in those lens systems which include two or moreviewing elements having refractive power) and/or one extreme of therange of motion of the lens system 100.

The stop members 190 shown in FIG. 22A are located on the first andsecond anterior translation members 110, 114 of the anterior biasingelement 108 and extend posteriorly therefrom. When the anterior andposterior viewing elements 106, 118 move together, one or more of thestop members 190 will contact the posterior translation member(s) 122,124, thereby preventing further convergent motion of the viewingelements 106, 118. Of course, in other embodiments the stop member(s)190 can be in any suitable location on the lens system 100.

FIGS. 44-48 depict another embodiment of the lens system 100 having anumber of stop members or separation members 190. In this embodiment thestop members 190 include posts 190 a and tabs 190 b, although it will beapparent that any number or combination of suitable shapes may beemployed for the stop members 190. Each of the stop members 190 has atleast one contact surface 191, one or more of which abuts an opposingsurface of the lens system 100 when the anterior and posterior viewingelements 106, 118 converge to a minimum separation distance SD (see FIG.47). In the embodiment shown, one or more of the contact surfaces 191 ofthe posts 190 a are configured to abut an opposing surface defined by asubstantially flat anterior perimeter portion 193 of the posteriorviewing element 118, when the viewing elements 106, 118 are at theminimum separation distance SD. One or more of the contact surfaces 191of the tabs 190 b are configured to abut opposing surfaces defined bysubstantially flat anterior faces 195 of the distending members 134,136, only if the viewing elements 106, 118 are urged together beyond theminimum separation distance SD. This arrangement permits the tabs 190 bto function as secondary stop members should the posts 190 a fail tomaintain separation of the viewing elements.

In other embodiments all of the contact surfaces 191 of the posts 190 aand tabs 190 b may be configured to contact their respective opposingsurfaces when the viewing elements 106, 118 are at the minimumseparation distance SD. In still further embodiments, the contactsurfaces 191 of the tabs 190 b may be configured to contact the opposingsurfaces when the viewing elements 106, 118 are at the minimumseparation distance SD and the contact surfaces 191 of the posts 190 aconfigured to contact the opposing surfaces only if the viewing elements106, 118 are urged together beyond the minimum separation distance SD.In one embodiment, the minimum separation distance SD is about 0.1-1.0mm; in another embodiment the minimum separation distance SD is about0.5 mm.

When one of the contact surfaces abuts one of the opposing surfaces, thetwo surfaces define a contact area CA (see FIG. 48, depicting an exampleof a contact area CA defined when the contact surface 191 of a post 190a contacts an opposing surface defined by the perimeter portion 193 ofthe posterior viewing element 118). Preferably, the contact surface andopposing surface are shaped to cooperatively minimize the size of thecontact area, to prevent adhesion between the contact surface and theopposing surface, which is often a concern when one or both of thesesurfaces has an adhesive affinity for the other. In the embodimentshown, this non-adhesive characteristic is achieved by employing asubstantially hemispherical contact surface 191 and a substantially flatopposing surface (perimeter portion 193). Of course, otherconfigurations can be selected for the contact surface(s) 191, includingconical, frustoconical, hemicylindrical, pyramidal, or other rounded,tapered or pointed shapes. All of these configurations minimize thecontact area CA while permitting the cross-sectional area CS of the stopmember 190 (such as the post 190 a depicted) to be made larger than thecontact area CA, to impart sufficient strength to the stop memberdespite the relatively small contact area CA. Indeed, when constructingthe contact surface(s) 191 any configuration may be employed whichdefines a contact area CA which is smaller than the cross-sectional areaCS of the stop member 190. As further alternatives, the contactsurface(s) 191 may be substantially flat and the opposing surface(s) mayhave a shape which defines, upon contact with the opposing surface, acontact area CA which is smaller than the cross-sectional area CS of thestop member. Thus, the opposing surface(s) may have, for example, ahemispherical, conical, frustoconical, hemicylindrical, pyramidal, orother rounded, tapered or pointed shape.

Other design features of the stop members 190 can be selected tomaximize their ability to prevent adhesion of the contact surface(s) tothe corresponding opposing surface(s), or adhesion to each other of anypart of the anterior and posterior portions 102, 104 of the lens system100. For example, the contact and opposing surfaces may be formed fromdissimilar materials to reduce the effect of any self-adhesive materialsemployed in forming the lens system 100. In addition the shape and/ormaterial employed in constructing one or more of the stop members 190can be selected to impart a spring-like quality to the stop member(s) inquestion, so that when the stop member is loaded in compression as theviewing elements are urged together at the minimum separation distance,the stop member tends to exert a resisting spring force, due to eitherbending or axial compression (or both) of the stop member, which in turnderive from the elasticity of the material(s) from which the stop memberis constructed, or the shape of the stop member, or both. Thisspringlike quality is particularly effective for inhibiting adhesion ofareas of the anterior and posterior portions 102, 104 other than thecontact surface(s) and opposing surface(s).

As used herein, the term “adhesion” refers to attachment to each otherof (i) an area of the anterior portion 102 of the lens system 100 and(ii) a corresponding area of the posterior portion 104 (other than theapices 112, 116), wherein such attachment is sufficiently strong toprevent, other than momentarily, the anterior and posterior viewingelements 106, 118 from moving apart along the optical axis under thebiasing force of the anterior and/or posterior biasing elements 108,120. If the areas in question are formed of different materials,adhesion may occur where at least one of the materials has an adhesiveaffinity for the other material. If the areas in question are formed ofthe same material, adhesion may occur where the material has an adhesiveaffinity for itself.

In the embodiment shown, four posts 190 a are positioned near theperimeter of the anterior viewing element 106, equally angularly spacedaround the optical axis. In addition, two tabs 190 b are located oneither side of the anterior viewing element, midway between the apices112, 116 of the lens system. Naturally, the number, type and/or positionof the stop members 190 can be varied while preserving the advantageousfunction of maintaining separation between the anterior and posteriorportions of the lens system.

The illustrated embodiment employs stop members 190 which extendposteriorly from the anterior portion 102 of the lens system 100, sothat the contact surfaces 191 are located on the posterior extremitiesof the stop members 190 and are configured to abut opposing surfacesformed on the posterior portion 104 of the lens system 100. However, itwill be appreciated that some or all of the stop members 190 may extendanteriorly from the posterior portion 104 of the lens system 100, sothat their contact surfaces 191 are located on the anterior extremitiesof the stop members 190 and are configured to abut opposing surfacesformed on the anterior portion 102 of the lens system 100.

VI. Mold Tooling

FIGS. 23-34 depict a mold system 500 which is suitable for molding thelens system 100 depicted in FIG. 3-17. The mold system 500 generallycomprises a first mold 502, a second mold 504 and a center mold 506. Thecenter mold 506 is adapted to be positioned between the first mold 502and the second mold 504 so as to define a mold space for injectionmolding or compression molding the lens system 100. The mold system 500may be formed from suitable metals, high-impact-resistant plastics or acombination thereof, and can be produced by conventional machiningtechniques such as lathing or milling, or by laser orelectrical-discharge machining. The mold surfaces can be finished ormodified by sand blasting, etching or other texturing techniques.

The first mold 502 includes a first mold cavity 508 with a firstanterior mold face 510 surrounded by an annular trough 512 and a firstperimeter mold face 514. The first mold 502 also includes a projection516 which facilitates easier mating with the second mold 504.

The center mold 506 includes a first center mold cavity 518 whichcooperates with the first mold cavity 508 to define a mold space forforming the anterior portion 102 of the lens system 100. The firstcenter mold cavity 518 includes a central anterior mold face 520 which,upon placement of the center mold 506 in the first mold cavity 508,cooperates with the first anterior mold face 510 to define a mold spacefor the anterior viewing element 106. In so doing, the first anteriormold face 510 defines the anterior face of the anterior viewing element106 and the central anterior mold face 520 defines the posterior face ofthe anterior viewing element 106. In fluid communication with thechamber formed by the first anterior mold face 510 and the centralanterior mold face 520 are lateral channels 522, 524 (best seen in FIG.31) which form spaces for molding the first and second transitionmembers 138, 140, along with the arms 110 a, 110 b of the first anteriortranslation member 110 as well as the arms 114 a, 114 b of the secondanterior translation member 114. The first center mold cavity 518 alsoincludes retention member cavities 526, 528 which define spaces formolding the first and second retention members 128, 130 to the anteriorviewing element 106.

The second mold 504 includes a second mold cavity 530 with a secondposterior mold space 532, a generally cylindrical transition 534extending therefrom and connecting to a second perimeter mold face 536.Lateral notches 538, 540 (best seen in FIGS. 26 and 27) are formed inthe second perimeter mold face 536. The second mold 504 also includes aninput channel 542 connected to an input channel opening 544 forintroducing material into the mold system 500. Also formed in the secondmold 504 is an output channel 546 and an output channel opening 548. Agenerally cylindrical rim 550 is included for mating with the projection516 of the first mold 502.

The center mold 506 includes a second center mold cavity 552 whichcooperates with the second mold cavity 530 to define a mold space forthe posterior portion 104 of the lens system 100. The second center moldcavity 552 includes a central posterior mold face 554 which, uponplacement of the center mold 506 in engagement with the second moldcavity 530, cooperates with the second posterior mold face 532 and thetransition 534 to define a chamber for forming the posterior viewingelement 118. In fluid communication with the chamber formed by thecentral posterior mold face 554 and the second posterior mold face 532are lateral channels 556, 558, 560, 562 which provide a mold space forforming the arms 122 a, 122 b of the first posterior translation member122 and the arms 124 a, 124 b of the second posterior translation member124. The second center mold cavity 552 includes lateral projections 564,566 which coact with the notches 538, 540 formed in the second moldcavity 530. The chambers formed therebetween are in fluid communicationwith the chamber defined by the central posterior mold face 554 and thesecond posterior mold face 532 to form the first and second distendingmembers 134, 136 integrally with the posterior viewing element 118.

The center mold 506 includes a first reduced-diameter portion 568 and asecond reduced-diameter portion 570 each of which, upon assembly of themold system 500, defines a mold space for the apices 112, 116 of thelens system 100.

In use, the mold system 500 is assembled with the center mold 506positioned between the first mold 502 and the second mold 504. Onceplaced in this configuration, the mold system 500 is held together underforce by appropriate techniques, and lens material is introduced intothe mold system 500 via the input channel 542. The lens material thenfills the space defined by the first mold 502, second mold 504, and thecenter mold 506 to take on the shape of the finished lens system 100.

The mold system 500 is then disassembled, and in one embodiment the lenssystem 100 is left in position on the center mold 506 after removal ofthe first and second molds 502, 504. This technique has been found toimprove the effectiveness of any polishing/tumbling/deflashingprocedures which may be performed (see further discussion below).Whether or not these or any other additional process steps areperformed, the lens system 100 is preferably removed from the centermold 506 while maintaining the interconnection of the various componentsof the lens system 100.

In another embodiment, the lens system 100 or a portion thereof isformed by a casting or liquid-casting procedure in which one of thefirst or second molds is first filled with a liquid and the center moldis placed then into engagement with the liquid-filled mold. The exposedface of the center mold is then filled with liquid and the other of thefirst and second molds is placed into engagement with the rest of themold system. The liquid is allowed or caused to set/cure and a finishedcasting may then removed from the mold system.

The mold system 500 can advantageously be employed to produce a lenssystem 100 as a single, integral unit (in other words, as a single pieceof material). Alternatively, various portions of the lens system 100 canbe separately molded, casted, machined, etc. and subsequently assembledto create a finished lens system. Assembly can be performed as a part ofcentralized manufacturing operations; alternatively, a physician canperform some or all of the assembly before or during the implantationprocedure, to select lens powers, biasing members, system sizes, etc.which are appropriate for a particular patient.

The center mold 506 is depicted as comprising an integral unit withfirst and second center mold cavities 518, 552. Alternatively, thecenter mold 506 may have a modular configuration whereby the first andsecond mold cavities 518, 552 may be interchangeable to adapt the centermold 506 for manufacturing a lens system 100 according to a desiredprescription or specification, or to otherwise change the power(s) ofthe lenses made with the mold. In this manner the manufacture of a widevariety of prescriptions may be facilitated by a set of mold cavitieswhich can be assembled back-to-back or to opposing sides of a main moldstructure.

FIGS. 49-53 depict one embodiment of a method for manufacturing thecenter mold 506. First, a cylindrical blank 1500 formed from anymaterial (such as Ultem) suitable for use in the mold tooling, is loadedinto a holder 1502 as shown in FIG. 49. The holder 1502 has a mainchamber 1504 which has an inner diameter substantially similar to thatof the blank 1500, a smaller-diameter secondary chamber 1506 rearward ofthe main chamber 1504, and a passage 1508 located rearward of thesecondary chamber 1506 and further defined by an annulus 1510. Theholder also includes two or more holder bores 1512 which facilitateattachment of the holder 1502 to a blocker (discussed in further detailbelow). The blank is “blocked” in the holder by filling the secondarychamber 1506 and passage 1508 with water-soluble wax 1514.

Once the blank 1500 has been loaded and blocked into the holder 1502,the holder 1502 is secured to a blocker 1516 by bolts or pins (notshown) which fit snugly into the holder bores 1512. The holder bores1512 align precisely with corresponding blocker bores 1517, by virtue ofa snug fit between the blocker bores 1517 and the bolts/pins. Theblocker-holder assembly is then loaded into a conventional machine tool,such as a lathe and/or a mill, and one of the first and second centermold cavities 518, 552 (the second cavity 552 is depicted in FIG. 51) ismachined from the exposed face of the blank 1500 using conventionalmachining techniques. The holder 1502 and blank 1500, with the secondcenter mold cavity 552 formed thereon, are then removed from the blocker1516 as shown in FIG. 51.

The main chamber 1504 is then filled with water-soluble wax 1520 forwardof the second center mold cavity 552, and the wax 1514 is removed fromthe secondary chamber 1506 and the passage 1508. Next the holder 1502 isfixed to the blocker 1516 with the as-yet unmodified portion of theblank 1500 facing outward. Upon re-loading the holder-blocker assemblyinto the machine tool, a portion of the annulus 1510 is then cut away tofacilitate tool access to the blank 1500. A series of machiningoperations are then performed on the blank 1500 until the remaining moldcavity (the first center mold cavity 518 is depicted in FIG. 53) hasbeen formed. The completed center mold 506 may then be removed from theholder 1502.

The machining technique depicted in FIGS. 49-53 is advantageous in thatit facilitates fabrication of the center mold 506 (with both the firstand second center mold cavities 518, 552) from a single piece ofmaterial. While it is possible to machine the first and second centermold cavities 518, 552 from separate pieces of material which aresubsequently glued together, such assembly creates a seam in the centermold which can retain contaminants and introduce those contaminants intothe mold when forming the lens system 100. In addition, the assembly ofthe center mold 506 from two halves introduces errors wherein the firstand second center mold cavities 518, 552 may be angularly shifted withrespect to each other about the optical axis, or wherein the moldcavities 518, 552 are non-concentric (i.e., shifted with respect to eachother in a direction orthogonal to the optical axis). The methoddepicted in FIGS. 49-53 eliminates these problems by retaining the blank1500 in the holder 1502 throughout the fabrication process and byenforcing precise axial alignment, via forced alignment of the bores1512 with the blocker bores 1517, when machining of both mold cavities.

In another embodiment, the center mold 506 is formed by a moldingprocess rather than by machining. The center mold 506 may be molded fromany of the materials disclosed herein as suitable for forming the lenssystem 100 itself, including but not limited to silicone, acrylics,polymethylmethacrylate (PMMA), block copolymers ofstyrene-ethylene-butylene-styrene (C-FLEX) or other styrene-basecopolymers, polyvinyl alcohol (PVA), polyurethanes, hydrogels or anyother moldable polymers or monomers.

The lens system which is formed when employing the molded center mold506 may itself be molded from the same material as the center mold 506.For example, the center mold 506 may be molded from silicone, and thenthe lens system 100 may be molded from silicone by using the mold system500 with the molded silicone center mold 506.

The center mold 506 can be molded by any suitable conventionaltechniques. A polished, optical quality initial mold set can be used tomake center molds which in turn will produce lens systems with opticalquality surfaces on the posterior face of the anterior optic, and theanterior face of the posterior optic. Alternatively (or additionally),the molded center mold can be polished and/or tumbled to produce anoptically-accurate center mold.

The molded center mold 506 offers several advantages over a machinedcenter mold. First, it is quicker, cheaper and easier to produce thecenter mold in large quantities by molding instead of machining. This inturn facilitates leaving the lens system in position on the center mold(see FIG. 54) while the lens system is tumbled, polished and/ordeflashed, without incurring undue expense. The presence of the centermold between the optics increases the effectiveness of thetumbling/polishing/deflashing by increasing the hoop strength of thelens system, so that the energy of the impacting tumbling beads is notdissipated in macroscopic deformation of the lens system. Molding alsopermits softer materials to be employed in forming the center mold, anda softer center mold is more resistant to damage from deflashing toolsand processes, resulting in fewer center molds lost to suchprocess-related damage.

VII. Materials and Adjustability

Preferred materials for forming the lens system 100 include silicone,acrylics, polymethylmethacrylate (PMMA), block copolymers ofstyrene-ethylene-butylene-styrene (C-FLEX) or other styrene-basecopolymers, polyvinyl alcohol (PVA), polyurethanes, hydrogels or anyother suitable polymers or monomers. In addition, any portion of thelens system 100 other than the optic(s) may be formed from stainlesssteel or a shape-memory alloy such as nitinol or any iron-basedshape-memory alloy. Metallic components may be coated with gold toincrease biocompatibility. Where feasible, material of a lower Shore Ahardness such as 15A may be used for the optic(s), and material ofhigher hardness such as 35A may be used for the balance of the lenssystem 100. Finally, the optic(s) may be formed from a photosensitivesilicone to facilitate post-implantation power adjustment as taught inU.S. patent application Ser. No. 09/416,044, filed Oct. 8, 1999, titledLENSES CAPABLE OF POST-FABRICATION POWER MODIFICATION, the entirecontents of which are hereby incorporated by reference herein.

Methyl-methylacrylate monomers may also be blended with any of thenon-metallic materials discussed above, to increase the lubricity of theresulting lens system (making the lens system easier to fold or roll forinsertion, as discussed further below). The addition ofmethyl-methylacrylate monomers also increases the strength andtransparency of the lens system.

The optics and/or the balance of the lens system 100 can also be formedfrom layers of differing materials. The layers may be arranged in asimple sandwich fashion, or concentrically. In addition, the layers mayinclude a series of polymer layers, a mix of polymer and metalliclayers, or a mix of polymer and monomer layers. In particular, a nitinolribbon core with a surrounding silicone jacket may be used for anyportion of the lens system 100 except for the optics; anacrylic-over-silicone laminate may be employed for the optics. A layeredconstruction may be obtained by pressing/bonding two or more layerstogether, or deposition or coating processes may be employed.

Where desired, the anterior optic may be formed from a materialdifferent from that used to form the posterior optic. This may be doneto take advantage of differences between the respective materials inrefractive index, mechanical properties or resistance to posteriorcapsule opacification (“PCO”), or to achieve an appropriate balance ofmechanical and optical properties. Additionally, the use of differingmaterials can increase resistance to intra-lenticular opacification(“ILO”). For example, the material forming the posterior optic may beselected for its resistance to PCO, and/or for its rigidity (so as toform a relatively rigid base for the biasing action of the biasingelements 108, 120, thereby maximizing anterior displacement of theanterior biasing element). Thus, the posterior optic may be formed fromacrylic; for example, a hydrophobic acrylic. The material forming theanterior optic may be selected for its high index of refraction, to keepto a minimum the size and weight of the anterior optic (and the lenssystem as a whole), thereby maximizing the range and speed of motion ofthe anterior optic in response to a given biasing force. To achievethese properties the anterior optic may be formed from silicone; forexample, high-refractive-index silicones (generally, silicones with arefractive index greater than about 1.43, or silicones with a refractiveindex of about 1.46).

In other embodiments, the anterior optic may be formed from any suitablematerial (including those disclosed herein), and the posterior optic maybe formed from any suitable material (including those disclosed herein)other than the material chosen to form the anterior optic. In oneembodiment the anterior optic is formed from silicone and the posterioroptic is formed from acrylic; in another embodiment the anterior opticis formed from acrylic and the posterior optic is formed from silicone.

The optics may be considered to be formed from different polymericmaterials where no more than about 10 mole percent of recurring units ofthe polymer employed in the anterior optic are the same as the primaryrecurring units of the polymer employed in the posterior optic; and/orwhere no more than about 10 mole percent of recurring units of thepolymer employed in the posterior optic are the same as the primaryrecurring units of the polymer employed in the anterior optic. Ingeneral, these conditions are desirable in order for the two materialsto have sufficiently different material properties. As used herein, a“primary” recurring unit of a given polymer is the recurring unit whichis present in such polymer in the greatest quantity by mole percentage.

In another embodiment, the optics may be considered to be formed fromdifferent polymeric materials where no more than about 10 mole percentof recurring units of the polymer employed in the anterior optic are ofthe same type as the primary recurring units of the polymer employed inthe posterior optic; and/or where no more than about 10 mole percent ofthe recurring units of the polymer employed in the posterior optic areof the same type as the primary recurring units of the polymer employedin the anterior optic. As used herein, recurring units of the same“type” are in the same chemical family (i.e., having the same or similarfunctionality) or where the backbone of the polymers formed by suchrecurring units is essentially the same.

In one embodiment, portions of the lens system 100 other than theoptic(s) are formed from a shape-memory alloy. This embodiment takesadvantage of the exceptional mechanical properties of shape-memoryalloys and provides fast, consistent, highly responsive movement of theoptic(s) within the capsular bag while minimizing material fatigue inthe lens system 100. In one embodiment, one or both of the biasingelements 108, 120 are formed from a shape-memory alloy such as nitinolor any iron-based shape-memory alloy. Due to the flat stress-straincurve of nitinol, such biasing elements provide a highly consistentaccommodation force over a wide range of displacement. Furthermore,biasing elements formed from a shape-memory alloy, especially nitinol,retain their spring properties when exposed to heat (as occurs uponimplantation into a human eye) while polymeric biasing elements tend tolose their spring properties, thus detracting from the responsiveness ofthe lens system. For similar reasons, it is advantageous to useshape-memory alloys such as those discussed above in forming any portionof a conventional (non-accommodating) intraocular lens, other than theoptic.

Where desired, various coatings are suitable for components of the lenssystem 100. A heparin coating may be applied to appropriate locations onthe lens system 100 to prevent inflammatory cell attachment (ICA) and/orposterior capsule opacification (PCO); naturally, possible locations forsuch a coating include the posterior biasing element 120 and theposterior face of the posterior viewing element 118. Coatings can alsobe applied to the lens system 100 to improve biocompatibility; suchcoatings include “active” coatings like P-15 peptides or RGD peptides,and “passive” coatings such as heparin and other mucopolysaccharides,collagen, fibronectin and laminin. Other coatings, including hirudin,teflon, teflon-like coatings, PVDF, fluorinated polymers, and othercoatings which are inert relative to the capsular bag may be employed toincrease lubricity at locations (such as the optics and distendingmembers) on the lens system which contact the bag, or Hema or siliconecan be used to impart hydrophilic or hydrophobic properties to the lenssystem 100.

It is also desirable subject the lens system 100 and/or the moldsurfaces to a surface passivation process to improve biocompatibility.This may be done via conventional techniques such as chemical etching orplasma treatment.

Furthermore, appropriate surfaces (such as the outer edges/surfaces ofthe viewing elements, biasing elements, distending members, retentionmembers, etc.) of the lens system 100 can be textured or roughened toimprove adhesion to the capsular bag. This may be accomplished by usingconventional procedures such as plasma treatment, etching, dipping,vapor deposition, mold surface modification, etc. As a further means ofpreventing ICA/PCO, a posteriorly-extending perimeter wall (not shown)may be added to the posterior viewing element 118 so as to surround theposterior face of the posterior optic. The wall firmly engages theposterior aspect of the capsular bag and acts as a physical barrier tothe progress of cellular ingrowth occurring on the interior surface ofthe capsular bag. Finally, the relatively thick cross-section of thepreferred anterior viewing element 118 (see FIGS. 9, 10) ensures that itwill firmly abut the posterior capsule with no localized flexing. Thus,with its relatively sharp rim, the posterior face of the preferredposterior viewing element 118 can itself serve as a barrier to cellularingrowth and ICA/PCO. In order to achieve this effect, the posteriorviewing element 118 is preferably made thicker than conventionalintraocular lenses. As an alternative or supplement to a thick posteriorviewing element, cell growth may be inhibited by forming a pronounced,posteriorly-extending perimeter rim on the posterior face of theposterior viewing element 118. Upon implantation of the lens system 100,the rim firmly abuts the inner surface of the capsular bag 58 and actsas a physical barrier to cell growth between the posterior face of theposterior viewing element 118 and the capsular bag 58.

The selected material and lens configuration should be able to withstandsecondary operations after molding/casting such as polishing, cleaningand sterilization processes involving the use of an autoclave, orethylene oxide or radiation. After the mold is opened, the lens shouldundergo deflashing, polishing and cleaning operations, which typicallyinvolve a chemical or mechanical process, or a combination thereof.Suitable mechanical processes include tumbling, shaking and vibration; atumbling process may involve the use of a barrel with varying grades ofglass beads, fluids such as alcohol or water and polishing compoundssuch as aluminum oxides. Process rates are material dependent; forexample, a tumbling process for silicone should utilize a 6″ diameterbarrel moving at 30-100 RPM. It is contemplated that several differentsteps of polishing and cleaning may be employed before the final surfacequality is achieved.

In one embodiment, the lens system 100 is held in a fixture to provideincreased separation between, and improved process effect on, theanterior and posterior viewing elements during thedeflashing/polishing/cleaning operations. In another embodiment, thelens system 100 is everted or turned “inside-out” so that the innerfaces of the viewing elements are better exposed during a portion of thedeflashing/polishing/cleaning. FIG. 34A shows a number of expansiongrooves 192 which may be formed in the underside of the apices 112, 116of the lens system 100 to facilitate eversion of the lens system 100without damaging or tearing the apices or the anterior/posterior biasingelements 108, 120. For the same reasons similar expansion grooves may beformed on the opposite sides (i.e., the outer surfaces) of the apices112, 116 instead of or in addition to the location of grooves on theunderside.

A curing process may also be desirable in manufacturing the lens system100. If the lens system is produced from silicone entirely at roomtemperature, the curing time can be as long as several days. If the moldis maintained at about 50 degrees C., the curing time is reduced toabout 24 hours; if the mold is preheated to 100-200 degrees C. thecuring time can be as short as about 3-15 minutes. Of course, thetime-temperature combinations vary for other materials.

In certain embodiments, it can be desirable to alter one or moreproperties of a lens system 100 after the system 100 has been implantedin the eye 50 of a patient. For example, it can be desirable to correctfor errors of ocular length and corneal curvature that may be made priorto implantation, improper positioning of the system 100 duringimplantation, and/or changes to the system 100 (e.g., movement of thesystem 100) that may occur after implantation as the patient heals. Insome embodiments, some or all of the system 100 can be modified moments,hours, days, weeks, or years after the system 100 has been implanted.The adjustments or modifications can occur non-invasively, such aswithout cutting the eye 50 in order to access the lens system 100,and/or can occur without physical manipulation of the system 100.Advantageously, such adjustments can allow a patient to approach orachieve ideal vision (e.g., emmetropia) without glasses or othercorrective lenses. In further advantageous embodiments, the system 100permits accommodation, and can be adjusted to improve near and/ordistant vision. In some situations, the lens system 100 can be modifiedpost-operatively to improve near vision by inducing myopia in a patient.In some embodiments, the system 100 can be modified in multiple stages,and can permit adjustments as the patient ages.

In some embodiments, some or all of the system 100 can be modified afterthe system has been implanted in the eye and before the patient has beenreleased. In some embodiments, some or all of the system can be modifiedafter a period of healing has occurred. For example, some or all of thesystem 100 may be modified 1, 2, 4, 6, or 8 weeks or more afterimplantation. In some embodiments, some or all of the system 100 may bemodified after it is has been determined that the eye's healing issubstantially complete or that the patient's vision has substantiallystabilized.

In certain embodiments, the shape and/or refractive properties of one ormore of the viewing elements 106, 118 of the lens system 100 are alteredin situ. In some embodiments, energy is applied to one or more of theelements 106, 118 to make the alterations without damaging surroundingocular structures. Energy can also be applied to stabilize the materialof which the elements 106, 118 are constructed, or to substantiallyprevent further changes to the molecular structure of the material, suchas further polymerization due to exposure to normal light conditions orother forms of energy. For example, in some embodiments, the power ofsome or all of the refractive components of the lens system 100 can bechanged (e.g., made more positive or more negative) by application offocused energy, and then “locked in” by application of additional energyto prevent further unwanted changes to the power of the system 100.

In some embodiments, one or more of the viewing elements 106, 118 cancomprise a composition capable of curing, undergoing stimulus-inducedpolymerization, or otherwise being induced to change properties in situ.Some suitable compositions are disclosed in U.S. Pat. Nos. 6,749,632,titled APPLICATION OF WAVEFRONT SENSOR TO LENSES CAPABLE OFPOST-FABRICATION POWER MODIFICATION; 7,074,840, titled LIGHT ADJUSTABLELENSES CAPABLE OF POST-FABRICATION POWER MODIFICATION VIA MULTI-PHOTONPROCESSES; 7,134,755, titled CUSTOMIZED LENSES; 6,917,416, titled LIGHTADJUSTABLE ABERRATION CONJUGATOR; and 7,119,894, titled LIGHT ADJUSTABLEABERRATION CONJUGATOR, the entire contents of each of which are herebyincorporated by reference herein and made a part of this specification.For example, in various embodiments, one or more of the viewing elements106, 118 (and/or some or all of the remainder of the lens system 100)can comprise polyacrylates such as polyalkyl acrylates andpolyhydroxyalkyl acrylates; polymethacrylates such as polymethylmethacrylate (“PMMA”), a polyhydroxyethyl methacrylate (“PHEMA”), andpolyhydroxypropyl methacrylate (“HPMA”); polyvinyls such as polystyreneand polyvinylpyrrolidone (“NVP”); polysiloxanes such aspolydimethylsiloxane; polyphosphazenes, and copolymers of thereof. Othersuitable materials are disclosed in U.S. Pat. No. 4,260,725, titledHYDROPHILIC CONTACT LENS MADE FROM POLYSILOXANES WHICH ARE THERMALLYBONDED TO POLYMERIZABLE GROUPS AND WHICH CONTAIN HYDROPHILIC SIDECHAINS,and in the patents and references cited therein; the entire contents ofeach of the foregoing items are incorporated by reference herein andmade a part of this specification.

In certain embodiments, polymerization is induced by application ofdelivery of energy, or energetic radiation, to the viewing elements 106,118. In some embodiments, the radiation comprises electromagneticradiation having a single wavelength or a relatively small band ofwavelengths, and may be provided by a laser or a light emitting diode.In other embodiments, the electromagnetic radiation comprises a band ofwavelengths, and may include optical, ultraviolet, or infraredradiation. Other forms of radiation can also be used, including electronbeam, microwave, radio frequency, or acoustic. Some suitablepolymerization methods, including specific wavelengths and power levelsthat can be used, are disclosed in U.S. Pat. No. 7,105,110, titledDELIVERY SYSTEM FOR POST-OPERATIVE POWER ADJUSTMENT OF ADJUSTABLE LENS,the entire contents of which are hereby incorporated by reference hereinand made a part of this specification.

In some embodiments, polymerization of the elements 106, 118 can alterthe refractive properties (e.g., the index of refraction) of theelements 106, 118. In further embodiments, polymerization of theelements 106, 118 can alter their shape (e.g., curvature). Therefractive properties and/or shape of one or more of the elements 106,118 thus can be modified to adjust the optical power of the elements106, 118. Also, the shape (e.g., curvature), index of refraction,refractive power, or other performance metric of any of the anterior orposterior surfaces of either of the anterior or posterior viewingelements 106, 118 can be modified to achieve the desired outcome.

In some embodiments, radiation is initially applied to only a portion ofone or more of the elements 106, 118. The radiation can be directed toor focused on a particular region of the elements 106, 118 and canpolymerize the region to modify the refractive properties and/or shapethereof. In further embodiments, radiation is applied to the remainingportion(s) of the element or elements 106, 118 to polymerize, stabilize,or substantially prevent changes to the properties of the remainingportion(s).

In some instances, one or more of the elements 106, 118 may alreadycomprise the desired optical properties prior to polymerization. Forexample, once a patient has healed from an implantation procedure, itmay be determined that the system 100 provides proper focusing ofincoming light over a full range of accommodation. Accordingly, in someembodiments, it may be desirable to cure or polymerize one or more ofthe elements 106, 118 substantially without changing the opticalproperties (e.g., the index of refraction or shape) of the elements. Incertain of such embodiments, substantially all of one or more of theelements 106, 118, or in further embodiments, substantially all of thesystem 100, can be irradiated at about the same time (e.g.,substantially simultaneously).

In some embodiments, only one of the elements 106, 118 is configured foralteration in situ, or one of the elements 106, 118 is substantiallymore alterable in situ than is the other of the elements. In someembodiments, only one of the elements 106, 118 is susceptible topolymerization under application of radiation, and the other of theelements 106, 118 is relatively unaffected by application of theradiation. For example, when both elements 106, 118 are formed from aunitary piece of material, one of the elements 106, 118 can bepolymerized by an energy source during fabrication of the lens system100 such that the polymerized lens would be relatively unaffected by anypolymerizing radiation subsequently applied to the system 100. Incertain of such embodiments, the un-polymerized or adjustable lens isprotected from the energy source during fabrication, such as, forexample, by a removable energy-reflective or energy-absorbing shield,cover, or coating.

In other embodiments, the elements 106, 118 comprise different materialssuch that each of the elements 106, 118 is susceptible to polymerizationby a different energy source. For example, in some embodiments, theanterior viewing element 106 can comprise a material configured topolymerize when exposed to a first band of UV radiation but not a secondband of UV radiation, and the posterior viewing element 118 can comprisea material configured to polymerize when exposed to the second band ofUV radiation but not the first band of UV radiation. Accordingly, insome embodiments, one of the elements 106, 118 can be selectivelyirradiated by an energy source substantially without polymerizing theother of the elements 118. In further embodiments, the anterior viewingelement 106 can be substantially transparent to the form of radiationcapable of polymerizing the posterior viewing element 118, which canfacilitate polymerization of the posterior viewing element 118. In stillother embodiments, only one of the elements 106, 118 is susceptible topolymerization.

In some embodiments, the posterior viewing element 118 is alterable andthe anterior viewing element 106 is not alterable, or is substantiallyless alterable. In certain of such embodiments, the anterior viewingelement 106 can be polymerized or otherwise treated to at leastpartially shield the posterior viewing element 118 from polymerizingenergy, such as UV rays. The anterior viewing element 106 thus canprotect the posterior viewing element 118 from undesired polymerizationprior to desired adjustment by a medical professional. The posteriorviewing element 118 can later be altered by exposing the element to anenergy source that the anterior viewing element 106 is transparent to,such as, for example, a different band of UV radiation orelectromagnetic radiation outside the UV range. In other embodiments,the anterior viewing element 106 is alterable and the posterior viewingelement 118 is not alterable, or is substantially less alterable. Insome embodiments, an implanted system 100 having only one element 106,118 susceptible to polymerization can be relatively easy to adjustbecause any polymerizing energy applied to the system 100 will affectonly one of the elements 106, 118.

In certain embodiments, both of the anterior and posterior viewingelements 106, 118 are alterable in situ. In some embodiments, bothelements 106, 118 are adjusted at approximately the same time. Forexample, in some instances, it may be desirable to determine whether animplantation was successful near the time of the implantation. Invarious situations, a patient may be evaluated from about 1 to about 3weeks after implantation, from about 2 to about 3 weeks afterimplantation, or after the eye has completely or substantially healed.In some instances, the system 100 may benefit from modifications at thetime of a post-implantation examination. Accordingly, one or more of theelements 106, 118 can be modified, as described above, and both can bepolymerized or stabilized to prevent further adjustments. In otherinstances, the system 100 may function as desired once the patient hashealed, and the elements 106, 118 can be polymerized or stabilized toprevent subsequent undesirable adjustments.

In some embodiments, the elements 106, 118 can be adjusted at separatetimes. For example, if the system 100 functions as desired at apost-implantation examination, rather than polymerizing or stabilizingthe elements 106, 118 at that time, one or more of the elements 106, 118can instead be modified at one or more subsequent dates to account forvision changes as the patient ages.

In some instances, one of the elements 106, 118 can be adjusted duringthe post-implantation examination, and the other of the elements 106,118 can be adjusted at a later time. In some embodiments, the first ofthe elements 106, 118 can adjusted to provide proper functioning of thesystem 100 near the time of the implantation, and the second of theelements 106, 118 is adjusted at a later time, which can be from about 1to 6 months, from about 1 to 12 months, from about 1 to 2 years, fromabout 1 to 3 years, from about 1 to 5 years, or from about 1 to 10 yearsafter implantation; or no less than about 6 months, no less than about 1year, no less than about 2 years, or no less than about 5 years afterimplantation. Accordingly, in various embodiments, the lens system 100can be adjusted at one or more dates to account for changes to thepatient's vision as the patient ages. In some embodiments, the anteriorviewing element 106 is adjusted prior to adjustment of the posteriorviewing element 118, which can help shield the posterior viewing element118 from undesired radiation, as described above.

In some embodiments, the lens system 100 can be adjusted by curing,polymerizing, or otherwise altering one or more portions of the system100 in addition to or instead of the viewing elements 106, 118. Forexample, in some embodiments, one or more support components of the lenssystem 100, such as the anterior biasing element 108, the posteriorbiasing element 120, the first apex 112, and the second apex 116, cancomprise any of the materials described above, and further, can beadjusted by irradiation.

In certain embodiments, polymerization of one or more support componentsof the lens system 100 alters the stiffness, spring constant, and/orshape of the one or more support components. Accordingly, in someembodiments, polymerization can affect the manner in which the system100 reacts to forces provided by the ciliary muscle 60. For example, insome embodiments, polymerization of one or more of the supportcomponents stiffens the components such that the viewing elements 106,118 are displaced relative to each other by a smaller amount when theciliary muscle 60 applies force to the system 100, as compared with thesystem 100 prior to polymerization. In some embodiments, polymerizationaffects the lens system's response time to changes in forces applied bythe eye, e.g. by increasing or decreasing the length of time requiredfor the lens to move from the unaccommodated state to the accommodatedstate and/or the time required for the lens to move from theaccommodated state to the unaccommodated state.

In some embodiments, alteration of the shape of one or more of thesupport components can move the viewing elements 106, 118 closertogether or further apart along the optical axis. Accordingly, in someembodiments, the power of the lens system 100 can be altered bypolymerizing the support components, independent of any changes made tothe properties of the viewing elements 106, 118. In some embodiments,polymerization affects the lens system's range of motion, e.g. byaffecting one or both of a separation distance between the anterior andposterior optic when the eye is in an unaccommodated state and aseparation distance between the anterior and posterior optic when theeye is in an accommodated state.

In some embodiments, the support structures are cured during fabricationof the lens system 100. In certain of such embodiments, one or more ofthe viewing elements 106, 118 are covered during fabrication in anysuitable manner, such as those described above, and the remainder of thelens system 100 is exposed to an energy source. In some embodiments, thesupport structures are substantially unaffected by radiation that maysubsequently be applied to the lens system 100 in situ, which canfacilitate alteration of the properties of one or more of the viewingelements 106, 118.

Any suitable portion of a lens system 100 may be pre-treated (e.g.,polymerized) to substantially prevent subsequent alteration of thatportion in situ. Similarly, any suitable portion of a lens system 100may be alterable (e.g., un-polymerized) to allow for subsequentadjustment of the system 100 in situ.

VIII. Multiple-Piece and Other Embodiments

FIG. 35 is a schematic view of a two-piece embodiment 600 of the lenssystem. In this embodiment the anterior portion 102 and the posteriorportion 104 are formed as separate pieces which are intended forseparate insertion into the capsular bag and subsequent assemblytherein. In one embodiment, each of the anterior and posterior portions102, 104 is rolled or folded before insertion into the capsular bag.(The insertion procedure is discussed in further detail below.) Theanterior portion 102 and posterior portion 104 are representedschematically as they may generally comprise any anterior-portion orposterior-portion structure disclosed herein; for example, they maysimply comprise the lens system 100 shown in FIGS. 3-17, bisected alongthe line/plane A-A shown in FIG. 4. The anterior portion 102 andposterior portion 104 of the two-piece lens system 600 will includefirst and second abutments 602, 604 which are intended to be placed inabutting relation (thus forming the first and second apices of the lenssystem) during the assembly procedure. The first and second abutments602, 604 may include engagement members (not shown), such as matchingprojections and recesses, to facilitate alignment and assembly of theanterior and posterior portions 102, 104.

As a further alternative, the anterior and posterior portions 102, 104of the lens system 600 may be hingedly connected at one of the abutments602, 604 and unconnected at the other, to allow sequential (butnonetheless partially assembled) insertion of the portions 102, 104 intothe capsular bag. The individual portions may be separately rolled orfolded before insertion. The two portions 102, 104 are “swung” togetherand joined at the unconnected abutment to form the finished lens systemafter both portions have been inserted and allowed to unfold/unroll asneeded.

FIG. 36 depicts schematically another embodiment 700 of a two-piece lenssystem. The lens system 700 is desirably similar to the lens system 600shown in FIG. 35, except for the formation of relatively larger, curledabutments 702, 704 which are assembled to form the apices 112, 116 ofthe system 700.

FIGS. 37 and 38 show a further embodiment 800 of the lens system, inwhich the anterior and posterior biasing elements 108, 120 compriseintegral “band” like members forming, respectively, the first and secondanterior translation members 110, 114 and the first and second posteriortranslation members 122, 124. The biasing elements 108, 120 also formreduced-width portions 802, 804 which meet at the apices of the lenssystem 800 and provide regions of high flexibility to facilitatesufficient accommodative movement. The depicted distending portion 132includes three pairs of distending members 134, 136 which have a curvedconfiguration but nonetheless project generally away from the opticalaxis.

FIGS. 38A and 38B depict another embodiment 900 of the lens system, asimplanted in the capsular bag 58. The embodiment shown in FIGS. 38A and38B may be similar to any of the embodiments described above, exceptthat the biasing elements 108, 120 are dimensioned so that the apices112, 116 abut the zonules 62 and ciliary muscles 60 when in theunaccommodated state as seen in FIG. 38A. In addition, the lens system900 is configured such that it will remain in the unaccommodated statein the absence of external forces. Thus, when the ciliary muscles 60contract, the muscles 60 push the apices 112, 116 closer together,causing the biasing elements 108, 120 to bow out and the viewingelements 106, 118 to separate and attain the accommodated state as shownin FIG. 38B. When the ciliary muscles 60 relax and reduce/eliminate theforce applied to the apices 112, 116 the biasing elements 108, 120 movethe lens system 900 to the unaccommodated state depicted in FIG. 38A.

FIGS. 38C and 38D depict biasers 1000 which may be used bias the lenssystem 100 toward the accommodated or unaccommodated state, depending onthe desired operating characteristics of the lens system. It istherefore contemplated that the biasers 1000 may be used with any of theembodiments of the lens system 100 disclosed herein. The bias providedby the biasers 1000 may be employed instead of, or in addition to, anybias generated by the biasing elements 108, 120. In one embodiment (seeFIG. 38C), the biasers 1000 may comprise U-shaped spring members havingapices 1002 located adjacent the apices 112, 116 of the lens system 100.In another embodiment (see FIG. 38D), the biasers 1000 may comprise anysuitable longitudinal-compression springs which span the apices 112, 116and interconnect the anterior and posterior biasing elements 108, 120.By appropriately selecting the spring constants and dimensions of thebiasers 1000 (in the case of U-shaped springs, the apex angle and armlength; in the case of longitudinal-compression springs, their overalllength), the biasers 1000 can impart to the lens system 100 a biastoward the accommodated or unaccommodated state as desired.

The biasers 1000 may be formed from any of the materials disclosedherein as suitable for constructing the lens system 100 itself. Thematerial(s) selected for the biasers 1000 may be the same as, ordifferent from, the material(s) which are used to form the remainder ofthe particular lens system 100 to which the biasers 1000 are connected.The number of biasers 1000 used in a particular lens system 100 may beequal to or less than the number of apices formed by the biasingelements of the lens system 100.

FIG. 38E depicts a further embodiment of the lens system 100 in whichthe anterior translation members 110 and the posterior translationmembers 120 are paired in a number (in the example depicted, four) ofseparate positioners 1400 which are radially spaced, preferably equallyradially spaced, about the optical axis. In the depicted embodiment, theanterior and posterior translation members 110, 120 connect directly tothe periphery of the viewing elements 106, 118; however, in otherembodiments any of the connection techniques disclosed herein may beemployed. As shown, the anterior translation members 100 preferablyextend anteriorly from the periphery of the anterior viewing elementbefore bending and extending posteriorly toward the apex/apices 112. Asdiscussed above, this configuration is advantageous for promotion offluid flow through an opening formed in the anterior aspect of thecapsular bag 58. It has been found that the lens configuration shown inFIG. 38E is well suited for the folding technique shown in FIGS. 40A and40B below. In additional embodiments, the lens system 100 shown in FIG.38E may incorporate any other suitable features of the other embodimentsof the lens system 100 disclosed herein, such as but not limited to thedistending members and/or retention members detailed above.

Any of the embodiments 100, 600, 700, 800, 900 of the lens system caninclude post-implantation adjustability, such as discussed above inSections II and VII with respect to the lens system 100. Accordingly, insome embodiments, any suitable portion of the any of the lens systems100, 600, 700, 800, 900 can comprise a material capable of beingadjusted in situ by application of energy thereto.

IX. Implantation Methods

Various techniques may be employed in implanting the various embodimentsof the lens system in the eye of a patient. The physician can firstaccess the anterior aspect of the capsular bag 58 via any appropriatetechnique. Next, the physician incises the anterior of the bag; this mayinvolve making the circular opening 66 shown in FIGS. 21 and 22, or thephysician may make a “dumbbell” shaped incision by forming two smallcircular incisions or openings and connecting them with a third,straight-line incision. The natural lens is then removed from thecapsular bag via any of various known techniques, such asphacoemulsification, cryogenic and/or radiative methods. To inhibitfurther cell growth, it is desirable to remove or kill all remainingepithelial cells. This can be achieved via cryogenic and/or radiativetechniques, antimetabolites, chemical and osmotic agents. It is alsopossible to administer agents such as P15 to limit cell growth bysequestering the cells.

In the next step, the physician implants the lens system into thecapsular bag. Where the lens system comprises separate anterior andposterior portions, the physician first folds or rolls the posteriorportion and places it in the capsular bag through the anterior opening.After allowing the posterior portion to unroll/unfold, the physicianadjusts the positioning of the posterior portion until it is withinsatisfactory limits. Next the physician rolls/folds and implants theanterior portion in a similar manner, and aligns and assembles theanterior portion to the posterior portion as needed, by causingengagement of mating portions, etc. formed on the anterior and posteriorportions.

Where the lens system comprises anterior and posterior portions whichare partially assembled or partially integral (see discussion above inthe section titled MULTIPLE-PIECE AND OTHER EMBODIMENTS), the physicianemploys appropriate implantation procedures, subsequentlyfolding/rolling and inserting those portions of the lens system that areseparately foldable/rollable. In one embodiment, the physician firstrolls/folds one portion of the partially assembled lens system and theninserts that portion. The physician then rolls/folds another portion ofthe partially assembled lens system and the inserts that portion. Thisis repeated until the entire system is inside the capsular bag,whereupon the physician completes the assembly of the portions andaligns the lens system as needed. In another embodiment, the physicianfirst rolls/folds all of the separately rollable/foldable portions ofthe partially assembled lens system and then inserts the rolled/foldedsystem into the capsular bag. Once the lens system is in the capsularbag, the physician completes the assembly of the portions and aligns thelens system as needed.

It is contemplated that conventional intraocular lens folding devices,injectors, syringes and/or shooters can be used to insert any of thelens systems disclosed herein. A preferred folding/rolling technique isdepicted in FIGS. 39A-39B, where the lens system 100 is shown first inits normal condition (A). The anterior and posterior viewing elements106, 118 are manipulated to place the lens system 100 in a low-profilecondition (B), in which the viewing elements 106, 118 are out of axialalignment and are preferably situated so that no portion of the anteriorviewing element 106 overlaps any portion of the posterior viewingelement 118, as viewed along the optical axis. In the low-profileposition (B), the thickness of the lens system 100 is minimized becausethe viewing elements 106, 118 are not “stacked” on top of each other,but instead have a side-by-side configuration. From the low-profilecondition (B) the viewing elements 106, 118 and/or other portions of thelens system 100 can be folded or rolled generally about the transverseaxis, or an axis parallel thereto. Alternatively, the lens system couldbe folded or rolled about the lateral axis or an axis parallel thereto.Upon folding/rolling, the lens system 100 is placed in a standardinsertion tool as discussed above and is inserted into the eye.

When the lens system 100 is in the low-profile condition (B), the systemmay be temporarily held in that condition by the use of dissolvablesutures, or a simple clip which is detachable or manufactured from adissolvable material. The sutures or clip hold the lens system in thelow-profile condition during insertion and for a desired time afterinsertion. By temporarily holding the lens system in the low-profilecondition after insertion, the sutures or clip provide time for fibrinformation on the edges of the lens system which, after the lens systemdeparts from the low-profile condition, may advantageously bind the lenssystem to the inner surface of the capsular bag.

The physician next performs any adjustment steps which are facilitatedby the particular lens system being implanted. Where the lens system isconfigured to receive the optic(s) in “open” frame members, thephysician first observes/measures/determines the post-implantation shapetaken on by the capsular bag and lens system in the accommodated and/orunaccommodated states and select(s) the optics which will provide theproper lens-system performance in light of the observed shapecharacteristics and/or available information on the patient's opticaldisorder. The physician then installs the optic(s) in the respectiveframe member(s); the installation takes place either in the capsular bagitself or upon temporary removal of the needed portion(s) of the lenssystem from the bag. If any portion is removed, a final installation andassembly is then performed with the optic(s) in place in the framemember(s).

Where the optic(s) is/are formed from an appropriate photosensitivesilicone as discussed above, the physician illuminates the optic(s)(either anterior or posterior or both) with an energy source such as alaser until they attain the needed physical dimensions or refractiveindex. The physician may perform an intervening step ofobserving/measuring/determining the post-implantation shape taken on bythe capsular bag and lens system in the accommodated and/orunaccommodated states, before determining any needed changes in thephysical dimensions or refractive index of the optic(s) in question.

FIG. 40 depicts a technique which may be employed during lensimplantation to create a fluid flow path between the interior of thecapsular bag 58 and the region of the eye anterior of the capsular bag58. The physician forms a number of fluid-flow openings 68 in theanterior aspect of the capsular bag 58, at any desired location aroundthe anterior opening 66. The fluid-flow openings 68 ensure that thedesired flow path exists, even if a seal is created between the anterioropening 66 and a viewing element of the lens system.

Where an accommodating lens system is implanted, the openings 68 createa fluid flow path from the region between the viewing elements of theimplanted lens system, and the region of the eye anterior of thecapsular bag 58. However, the technique is equally useful for use withconventional (non-accommodating) intraocular lenses.

FIGS. 40A and 40B illustrate another embodiment of a method of foldingthe lens system 100. In this method the anterior viewing element 106 isrotated approximately 90 degrees about the optical axis with respect tothe posterior viewing element 118. This rotation may be accomplished byapplying rotational force to the upper edge of the first transitionmember 138 and the lower edge of the second transition member 140 (orvice versa), as indicated by the dots and arrows in FIG. 40A, whileholding the posterior viewing element 118 stationary, preferably bygripping or clamping the distending members 134, 136. Alternatively,rotational force may be applied in a similar manner to a right edge ofone of the retention members 128, 130 and to a left edge of the other ofthe retention members while holding the posterior viewing element 118stationary. As still further alternatives, the anterior viewing element106 could be held stationary while rotational force is applied to theposterior viewing element 118, at an upper edge of one of the distendingmembers 134, 136 and at a lower edge of the other of the distendingmembers; or both the anterior and posterior viewing elements 106, 118could be rotated with respect to each other.

Preferably, the viewing elements 106, 118 are spread apart somewhat asthe rotation is applied to the lens system so that the translationmembers and apices are drawn into the space between the viewing elements106, 118 in response to the rotational force. Once the anterior viewingelement 106 has been rotated approximately 90 degrees about the opticalaxis with respect to the posterior viewing element 118, the lens system100 takes on the configuration shown in FIG. 40B, with the retentionmembers 128, 130 generally radially aligned with the distending members134, 136 and the translation members and apices disposed between theviewing elements 106, 118. This configuration is advantageous forinserting the lens system 100 into the capsular bag 58 because itreduces the insertion profile of the lens system 100 while storing alarge amount of potential energy in the translation members. From thefolded configuration the translation members thus exert a high “rebound”force when the lens system has been inserted to the capsular bag 58,causing the lens system to overcome any self-adhesion and spring back tothe unfolded configuration shown in FIG. 40A without need for additionalmanipulation by the physician.

Once the lens system 100 is in the folded configuration shown in FIG.40B, it may be further folded and/or inserted into the capsular bag 58by any suitable methods presently known in the art or hereafterdeveloped. For example, as shown in FIG. 40C the folding method mayfurther comprise inserting the folded lens system 100 between the prongs1202, 1204 of a clip 1200, preferably with the prongs 1202, 1204oriented to extend along the transition members 138, 140, or along theretention members 128, 130 and the distending members 134, 136.

FIGS. 40D-40F illustrate the use of jaws 1250, 1252 of a pliers orforceps to fold the lens system 100 as it is held in the clip 1200.(FIGS. 40D-40F show an end view of the clip-lens system assembly withthe jaws 1250, 1252 shown in section for clarity.) As shown in FIGS. 40Dand 40E, the edges of the jaws 1250, 1252 are urged against one of theanterior and posterior viewing elements 106, 118 while the jaws 1250,1252 straddle the prong 1202 of the clip 1200. The resulting three-pointload on the lens system 1200 causes it to fold in half as shown in FIG.40E. As the lens system 100 approaches the folded configuration shown inFIG. 40F, the jaws 1250, 1252 slide into a pincer orientation withrespect to the lens system 100, characterized by contact between theinner faces 1254, 1256 of the jaws 1250, 1252 and the anterior viewingelement 106 or posterior viewing element 118. With such a pincerorientation established, the forceps may be used to grip and compressthe lens system with inward-directed pressure and the clip 1200 can bewithdrawn, as shown in FIG. 40F. With the lens system 100 thus folded,it can be inserted to the capsular bag 58 by any suitable methodpresently known in the art or hereafter developed.

FIG. 40G depicts a folding tool 1300 which may be employed to fold thelens system 100 as discussed above in connection with FIGS. 40A and 40B.The tool 1300 includes a base 1302 with brackets 1304 which hold thelens system 100 to the base 1302 by gripping the distending members 134,136. Formed within the base 1302 are arcuate guides 1306. The toolfurther comprises a rotor 1308 which in turn comprises a horizontal rod1310 and integrally formed vertical rods 1312. The vertical rods 1312engage the arcuate guides 1306, both of which have a geometric center onthe optical axis of the lens system 100. The vertical rods 1312 and thearcuate guides 1306 thus coact to allow the horizontal rod to rotate atleast 90 degrees about the optical axis of the lens system 100. Thehorizontal rod 1310 is fixed with respect to the anterior viewingelement 106 of the lens system 100 so as to prevent substantially norelative angular movement between the rod 1310 and the anterior viewingelement 106 as the rod 1310 (and, in turn, the anterior viewing element106) rotates about the optical axis of the lens system 100. This fixedrelationship may be established by adhesives and/or projections (notshown) which extend downward from the horizontal rod 1308 and bearagainst the upper edge of one of the transition members 138, 140 andagainst the lower edge of the other of the transition members as shownin FIG. 40A. As an alternative or as a supplement to this arrangement,the projections may bear against the retention members 128, 130 in asimilar manner as discussed above.

Thus, when the rotor 1308 is advanced through its range of angularmotion about the optical axis of the lens system 100, it forces theanterior viewing element 106 to rotate in concert therewith about theoptical axis, folding the lens system as discussed above in connectionwith FIGS. 40A and 40B. It is further contemplated that the folding tool1300 may comprise the lower half of a package in which the lens systemis stored and/or shipped to a customer, to minimize the labor involvedin folding the lens system at the point of use. Preferably, the lenssystem is stored in the tool 1300 in the unfolded configuration, so asto avoid undesirable deformation of the lens system.

X. Thin Optic Configurations

In some circumstances it is advantageous to make one or more of theoptics of the lens system relatively thin, in order to facilitaterolling or folding, or to reduce the overall size or mass of the lenssystem. Discussed below are various optic configurations whichfacilitate a thinner profile for the optic; any one of theseconfigurations may be employed as well as any suitable combination oftwo or more of the disclosed configurations.

One suitable technique is to employ a material having a relatively highindex of refraction to construct one or more of the optics. In oneembodiment, the optic material has an index of refraction higher thanthat of silicone. In another embodiment, the material has an index ofrefraction higher than about 1.43. In further embodiments, the opticmaterial has an index of refraction of about 1.46, 1.49 or 1.55. Instill further embodiments, the optic material has an index of refractionof about 1.43 to 1.55. By employing a material with a relatively highindex of refraction, the curvature of the optic can be reduced (in otherwords, the radius/radii of curvature can be increased) thereby reducingthe thickness of the optic without loss of focal power.

A thinner optic can also be facilitated by forming one or more of thesurfaces of one or more of the optics as an aspheric surface, whilemaintaining the focal power of the optic. As shown in FIG. 41, anaspheric, convex optic surface 1100 can be formed with the same radiusof curvature (as a comparable-power spherical surface) at the vertex1102 of the surface 1100 and a longer radius of curvature (with a commoncenter point) at its periphery 1104, creating a thinner optic withoutsacrificing focal power. This contrasts with a spherical optic surface1106, which is thicker at its vertex 1108 than is the aspheric surface1102. In one embodiment, the thickness of the optic is reduced by about19% at the vertex relative to a comparable-power spherical optic. It iscontemplated that thinner, aspheric concave optic surfaces may be usedas well. A further advantage of an aspheric optic surface is that itprovides better image quality with fewer aberrations, and facilitates athinner optic, than a comparable spherical surface.

FIG. 42 depicts a further strategy for providing a thinner optic 1150.The optic 1150 has a curved (spherical or aspheric) optic surface 1152and a flat or planar (or otherwise less curved than a comparablerefractive surface) diffractive optic surface 1154 in place of a secondcurved surface 1156. The diffractive optic surface 1154 can comprise anysuitable diffraction grating, including the grooved surface depicted orany other diffractive surface presently known or hereafter developed,including holographic optical elements. By appropriately configuring thediffractive surface 1154 as is well known in the art, the optic 1150 canbe made thinner than one having both curved surfaces 1152, 1154, whileproviding the same focal power. The use of the diffractive surface 1154not only facilitates a thinner optic, but also reduces aberrations inthe resulting image.

A further alternative for facilitating a thin, easy-to-fold optic is toemploy, in place of a biconvex optic of refractive index greater thanaqueous humor (i.e., greater than about 1.336), a biconcave optic ofrefractive index less than about 1.336, which is thinner at the opticalaxis than the biconvex optic. By constructing the biconcave optic ofmaterial having a refractive index less than about 1.336, the biconcaveoptic can be made to have the same effective focal power, when immersedin aqueous humor, as a given biconvex optic.

Still another alternative thin optic, shown in FIG. 43, is a biconcaveoptic 1160 of low refractive index (for example, about 1.40 or less orabout 1.336 or less) which is clad with first and second claddingportions 1162, 1164 constructed of higher-index material (for example,about 1.43 or greater). Such an optic can be made to have the sameeffective focal power, when immersed in aqueous humor, as a thickerbiconvex optic.

As a further alternative, one or more of the surfaces of the optics maybe formed as a multifocal surface, with spherical and/or aspheric focalregions. A multifocal surface can be made with less curvature than acomparable-power single-focus surface and thus allows the optic to bemade thinner. The additional foci provide added power which replaces orexceeds the power that is “lost” when the surface is reduced incurvature. In one embodiment, the multifocal optic is constructed as aconcentric-ring, refractive optic. In another embodiment, the multifocaloptic is implemented as a diffractive multifocal optic.

Although the inventions have been disclosed in the context of certainpreferred embodiments and examples, it will be understood by thoseskilled in the art that the present inventions extend beyond thespecifically disclosed embodiments to other alternative embodimentsand/or uses of the inventions and obvious modifications and equivalentsthereof. Thus, it is intended that the scope of the present inventionsherein disclosed should not be limited by the particular disclosedembodiments described above, but should be determined only by a fairreading of the claims that follow.

1. A method of adjusting an intraocular lens after implantation in aneye, the intraocular lens having an anterior optic, a posterior optic,and a support structure configured to move the optics relative to eachother along an optical axis between an accommodated state and anunaccommodated state, the method comprising: non-invasively applyingenergy to at least a portion of said support structure while the lens isin the eye to alter reaction forces between the support structure and atleast one structure of the eye.
 2. The method of claim 1, wherein saidsupport structure comprises an anterior biasing element, a posteriorbiasing element, a first apex, and a second apex, and wherein said stepof non-invasively applying energy comprises applying energy to at leastone of said anterior biasing element, said posterior biasing element,said first apex, or said second apex.
 3. The method of claim 1, whereinsaid step of non-invasively applying energy is configured to alter atleast one of a stiffness, a spring constant, or a shape of said supportstructure.
 4. The method of claim 3, wherein said step of non-invasivelyapplying energy is configured to stiffen said at least portion of saidsupport structure.
 5. The method of claim 1, wherein said step ofnon-invasively applying energy is configured to adjust a relativeseparation of said anterior optic and said posterior optic when saidlens is in the accommodated state.
 6. A method of adjusting anintraocular lens after implantation in an eye, the intraocular lenshaving a first optic and a second optic, the method comprising:non-invasively applying energy to at least a portion of said first opticwhile the lens is in the eye to adjust a refractive property of saidfirst optic while leaving refractive properties of said second opticsubstantially unaffected; non-invasively applying energy to at least aportion of said second optic while the lens is in the eye to adjust arefractive property of said second optic while leaving refractiveproperties of said first optic substantially unaffected.
 7. The methodof claim 6, wherein said step of non-invasively applying energy to saidfirst optic comprises applying energy from a first energy source andwherein said step of non-invasively applying energy to said second opticcomprises applying energy from a second source different from said firstsource.
 8. The method of claim 7, wherein said step of applying energyfrom a first source comprises applying UV radiation in a first band andwherein said step of applying energy from a second source comprisesapplying UV radiation in a second band.
 9. The method of claim 7,wherein said step of applying energy from a first energy source to saidfirst optic is performed at a first time, and wherein said step ofapplying energy from a second energy source to said second optic isperformed at a second time after said first time.
 10. The method ofclaim 9, wherein said anterior optic is adjusted at said first time andsaid posterior optic is adjusted at said second time.
 11. The method ofclaim 10, wherein said step of adjusting said anterior optic at saidfirst time shields said posterior optic from undesired radiation. 12.The method of claim 7 wherein said steps of applying energy from a firstsource and applying energy from a second source are performed atapproximately the same time.
 13. A method of adjusting an intraocularlens after implantation in an eye, the intraocular lens having ananterior optic and a posterior optic, the method comprising:non-invasively applying energy to at least a portion of one of saidanterior optic and said posterior optic while the lens is in the eye toalter a refractive property of said one of said optics while leavingrefractive properties of a remaining one of said optics substantiallyunaffected.
 14. The method of claim 13, the method further comprisingsubsequently applying energy to a remaining portion of said one of saidoptics to thereby prevent subsequent alteration of said remainingportion.
 15. The method of claim 13, the method further comprisingnon-invasively applying energy to said portion of said one of saidoptics to prevent subsequent alteration of said one of said optics. 16.The method of claim 13, wherein said step of non-invasively applyingenergy comprises non-invasively applying energy to at least a portion ofsaid posterior optic to thereby alter a refractive property of saidposterior optic and wherein said anterior optic is configured such thatrefractive properties of said anterior optic are substantiallyunaffected by said applied energy.
 17. The method of claim 16, furthercomprising at least partially shielding said posterior optic from UVrays with said anterior optic to thereby prevent undesiredpolymerization of said posterior optic prior to desired adjustment by amedical professional.
 18. The method of claim 17, wherein said step ofnon-invasively applying energy comprises exposing said posterior opticto an energy source to which said anterior optic is substantiallytransparent.
 19. The method of claim 13, wherein said step ofnon-invasively applying energy comprises applying energy that issubstantially single-wavelength.
 20. The method of claim 13, whereinsaid step of non-invasively applying energy comprises applying energyhaving a band of wavelengths.
 21. The method of claim 13, wherein saidstep of non-invasively applying energy comprises applying one or more ofelectron beam, microwave, radio frequency, or acoustic energy.
 22. Themethod of claim 13, wherein said step of non-invasively applying energychanges a shape of said one of said optics.